So has Obamacare worked? Has it not? Is it helping or hurting?

[sunzt]

One part of Obamacare is forcing almost every medical provider (hospitals, private practices, physical therapists) to update their systems to electronic ones. Has been going on for the last few years, and the benefits are more geared towards serviceability, more accurate care, and traceability of medical records. In other words, being more efficient in the workplace. This doesn't necessarily mean reduced cost to consumers.

 

[Texashiker]

One part of Obamacare is forcing almost every medical provider (hospitals, private practices, physical therapists) to update their systems to electronic ones. Has been going on for the last few years, and the benefits are more geared towards serviceability, more accurate care, and traceability of medical records. In other words, being more efficient in the workplace. This doesn't necessarily mean reduced cost to consumers.

Have you talked to very many doctors about EMRs?

The doctors I spoke to hate it. The doctors spend more time entering into the EMR system then caring for patients.

Clinics and hospitals do not want to hire someone full time to enter information for the doctor, so the doctor is left to enter their own information.

The more time the doctor spends entering information into EMRs, the less time they have to see pts.

And its debatable if EMRs even improve care.

 

[EagleKeeper]

The company I work for is call Mckinstry. They have a large construction sector in the Seattle area, and as far as I know, they are all Union. I work in facilities sector, we are not union, although I wish we were. We facilitate Data centers in, Prineville OR, NC, Arizona, Colorado, Cupertino, and Utah, where I am. My provider is First health/ Health Comp and I believe the dental is delta. But I am not 100%. I had rotator cuff surgery in April, I payed about 700 bucks including PT and I didn't even reach my maximum out of pocket for the year which is 1000. The coverage is fairly standard, but the dental has almost everything covered at 80% except for a few major things and orthodontia which is allotted 1500 per lifetime. And starting wage where I work is about $25 an hour and tops out about $32 if you aren't a supervisor. Plus 128 hours of PTO and they pay for your gym membership and give you a company phone (iPhone).

thanks for the info. :thumbsup:

I have had Delta for Dental previously and had no issues with their coverage.

 

[EagleKeeper]

One part of Obamacare is forcing almost every medical provider (hospitals, private practices, physical therapists) to update their systems to electronic ones. Has been going on for the last few years, and the benefits are more geared towards serviceability, more accurate care, and traceability of medical records. In other words, being more efficient in the workplace. This doesn't necessarily mean reduced cost to consumers.

Someone has to pay for all the equipment.

And then those that make the equipment get taxed extra besides.

 

[Juddog]

Have you talked to very many doctors about EMRs?

The doctors I spoke to hate it. The doctors spend more time entering into the EMR system then caring for patients.

Clinics and hospitals do not want to hire someone full time to enter information for the doctor, so the doctor is left to enter their own information.

The more time the doctor spends entering information into EMRs, the less time they have to see pts.

And its debatable if EMRs even improve care.

I've personally known people that have died because of a lack of EMR. EMR is really a necessity in this day and age.

 

[sunzt]

Have you talked to very many doctors about EMRs?

The doctors I spoke to hate it. The doctors spend more time entering into the EMR system then caring for patients.

Clinics and hospitals do not want to hire someone full time to enter information for the doctor, so the doctor is left to enter their own information.

The more time the doctor spends entering information into EMRs, the less time they have to see pts.

And its debatable if EMRs even improve care.

The reason many doctors seem to hate it, especially the older ones, is because of the new technology they have to use. Many of them don't even know how to type. They will learn it and leverage it more efficiently as time goes on.

It's really similar to how computers were introduced to the workplace and forcing every employee to learn how to use word/excel, etc rather than using paper and pen for everything.

 

[Texashiker]

Someone has to pay for all the equipment.

Tax payers are paying for a large percentage of it.

A local doctor I do side jobs for was sold a new EMR system. For a single doctor practice he was told he needed a dell 610 dual xeon quad core server with something like 32 gigs of memory, 2 laptops, and 3 new workstations.

This replaced his dell workstations that were just a couple of years old, and his windows 2003 server.

The grand total was close to $20k, and is was for a single doctor practice.

Out of that $20k, the government was going to reimburse around 75% of the total cost.

The reason many doctors seem to hate it, especially the older ones, is because of the new technology they have to use. Many of them don't even know how to type. They will learn it and leverage it more efficiently as time goes on.

That is true.

But,,, how much time is going to be wasted for doctors who are close to retiring?

 

[sunzt]

Someone has to pay for all the equipment.

And then those that make the equipment get taxed extra besides.

It's the practice that pays. And you can say they are "creating jobs" by hiring consulting firms to implement these systems.

 

[Juddog]

The reason many doctors seem to hate it, especially the older ones, are because of the new technology they have to use. Many of them don't even know how to type. They will learn it and leverage it more efficiently as time goes on.

It's really similar to how computers were introduced to the workplace and forcing every employee to learn how to use word/excel, etc rather than using paper and pen for everything.

^^ Exactly - and all the old timers hated it. The newer gen workers had no problems with it, learned the system, and became more efficient. Stalling the future just because you are near retirement and don't feel like learning a new system is backwards thinking, in my opinion.

We can't even begin to use more complex data analytics until all medical records are made electronic; right now there is an unbelievable amount of bloat, fraud, waste, and abuse in the medical system, in insurance, and in pharmacology. That waste needs to be checked now; it's already at the point where it's growing out of control, way faster than inflation. I guarantee there are a lot of people milking the system via fraud, bad subscriptions being made (abuse), and many unnecessary procedures being done that may not be the best (waste).

This is why the healthcare system is out of control and needs to be checked, and I don't care if it's a Republican or Democrat that does the ass-kicking to get this country's healthcare system back in shape, I'd vote for them regardless of party affiliation. This has gotten to the point of ridiculousness, and it's only going to get worse before it gets better. If you look at the healthcare expenses over the past 15 years it continues to grow at a much faster rate than inflation and it doesn't take a genius to see that something is seriously wrong with the system.

EMR is the first step to finding out where the healthcare system is going wrong, without it we are doomed to continue down the path we're going.

 

[sunzt]

That is true.

But,,, how much time is going to be wasted for doctors who are close to retiring?

I'd consider computer literacy a life skill. Anything new always has a learning curve. If anything, learning the skill will make them become more productive and provide better care. So it's an "investment" rather than "wasted time".

 

[Londo_Jowo]

I've personally known people that have died because of a lack of EMR. EMR is really a necessity in this day and age.

I'm glad that EMR is in place, it recently caught a potentially deadly drug interaction with my current medications when the Doctor entered a new prescription for me recently. Thankfully he was able to prescribe a different medication and I didn't have to deal with a bad drug interaction.

 

[Juddog]

I'm glad that EMR is in place, it recently caught a potentially deadly drug interaction with my current medications when the Doctor entered a new prescription for me recently. Thankfully he was able to prescribe a different medication and I didn't have to deal with a bad drug interaction.

^^ This is basically what happened with my grandma - had the EMR been in place, they would have caught the issue with multiple medications, but they didn't, and she died.

 

[Hayabusa Rider]

The company I work for is call Mckinstry. They have a large construction sector in the Seattle area, and as far as I know, they are all Union. I work in facilities sector, we are not union, although I wish we were. We facilitate Data centers in, Prineville OR, NC, Arizona, Colorado, Cupertino, and Utah, where I am. My provider is First health/ Health Comp and I believe the dental is delta. But I am not 100%. I had rotator cuff surgery in April, I payed about 700 bucks including PT and I didn't even reach my maximum out of pocket for the year which is 1000. The coverage is fairly standard, but the dental has almost everything covered at 80% except for a few major things and orthodontia which is allotted 1500 per lifetime. And starting wage where I work is about $25 an hour and tops out about $32 if you aren't a supervisor. Plus 128 hours of PTO and they pay for your gym membership and give you a company phone (iPhone).

Sounds like a "Cadillac" plan. If that's true then you are going to get screwed, but that's the purpose of the plan and a good thing, or so I'm told. If it's not then no one knows.

 

[Hayabusa Rider]

This is just from memory when the debates over health care reform were taking place, but weren't we supposed to be modeled after the Swiss system, not socialized medicine in English or Canadian sense?

Doesn't help that instead of really trying to write best laws possible, wing nuts in Congress keep trying to repeal it, and let lobbyists for insurance companies write all laws without creating any sort of outcry on mainstream media.

No one wanted to even know what needed or best. For example you want to measure success by costs. That's easy. Don't make expensive treatments available. Instant savings.

 

[TheSiege]

Sounds like a "Cadillac" plan. If that's true then you are going to get screwed, but that's the purpose of the plan and a good thing, or so I'm told. If it's not then no one knows.

It's not a Cadillac Plan

 

[mshan]

Cost and effectiveness (bang for the buck):

"Switzerland’s healthcare spending isn’t cheap either — it costs nearly $5,350 per resident.

But while costs here have risen by roughly 3.5% for the past two years — reflected in annual premium hikes — an analysis conducted in 2010 by Organization for Economic Cooperation and Development found that out of 29 countries it studied, Switzerland was among the most effective in getting better health outcomes for money spent.

There are several reasons why Switzerland manages to control spending while keeping its population healthy: universal coverage reduces the need, and therefore the cost, for emergency room visits for non-urgent complaints, and the government regulates drug prices and fees for medical tests."

http://nation.time.com/2012/08/16/h...d-has-its-own-kind-of-obamacare-and-loves-it/

 

[Juddog]

Cost and effectiveness (bang for the buck):

http://nation.time.com/2012/08/16/h...d-has-its-own-kind-of-obamacare-and-loves-it/

Too bad that if we tried implementing the exact same system, a certain batch of people would attack it because it goes against the interests of health insurance companies (it would be blasted as "socialism").

 

[werepossum]

^^ Exactly - and all the old timers hated it. The newer gen workers had no problems with it, learned the system, and became more efficient. Stalling the future just because you are near retirement and don't feel like learning a new system is backwards thinking, in my opinion.

We can't even begin to use more complex data analytics until all medical records are made electronic; right now there is an unbelievable amount of bloat, fraud, waste, and abuse in the medical system, in insurance, and in pharmacology. That waste needs to be checked now; it's already at the point where it's growing out of control, way faster than inflation. I guarantee there are a lot of people milking the system via fraud, bad subscriptions being made (abuse), and many unnecessary procedures being done that may not be the best (waste).

This is why the healthcare system is out of control and needs to be checked, and I don't care if it's a Republican or Democrat that does the ass-kicking to get this country's healthcare system back in shape, I'd vote for them regardless of party affiliation. This has gotten to the point of ridiculousness, and it's only going to get worse before it gets better. If you look at the healthcare expenses over the past 15 years it continues to grow at a much faster rate than inflation and it doesn't take a genius to see that something is seriously wrong with the system.

EMR is the first step to finding out where the healthcare system is going wrong, without it we are doomed to continue down the path we're going.

With the kind of horsepower usually specified, voice recognition via a medical package would be no biggy.

I knew a guy who had lost his legs due to a doctor not noticing on his chart that he was diabetic and prescribing a medication dangerous to diabetics. And personally, when I was in the hospital for an ileus caused by ignoring gall bladder attacks, I had one doctor (who had never seen me) prescribe a blood thinner even though another doctor (who had also never seen me) was scheduled to remove my gall bladder twelve hours later. Software that can guard against such things has a great deal of value in my opinion.

Such software, if centrally kept and properly analyzed, can also demonstrate the relative efficacy of various treatments. On the flip side, each of us has to decide if forfeiting that level of privacy is worth the payback.

 

[Thump553]

For the most part Obamacare doesn't take effect until January 1, 2014 at the earliest, so it's far too early to judge. I'm self employed and from looking at the projected numbers I'm thrilled. No more $15K deductible, most likely better coverage and the monthly premium is going to plummet.

But I live in a state where the government is trying to implement Obamacare instead of doing everything possible to sabotage it. Nationally the GOP is going through it's final last ditch battles to derail Obamacare because they know once it takes effect nearly all rational people will flee from that party's positions. Especially where, despite having had literally years now to come up with a viable alternative, the GOP has proposed nothing but vague platitudes.

BTW werepossum's post above points out a huge problem. I had similar problems with both my mother and father in the last years of their (then) heavily doctored & medicated lives-including the same one of Doctor A prescibing a blood thinner when Doctor B was planning surgery. Hoperfully the electronic records changes will solve at least some of this.

 

[Juddog]

With the kind of horsepower usually specified, voice recognition via a medical package would be no biggy.

I knew a guy who had lost his legs due to a doctor not noticing on his chart that he was diabetic and prescribing a medication dangerous to diabetics. And personally, when I was in the hospital for an ileus caused by ignoring gall bladder attacks, I had one doctor (who had never seen me) prescribe a blood thinner even though another doctor (who had also never seen me) was scheduled to remove my gall bladder twelve hours later. Software that can guard against such things has a great deal of value in my opinion.

Such software, if centrally kept and properly analyzed, can also demonstrate the relative efficacy of various treatments. On the flip side, each of us has to decide if forfeiting that level of privacy is worth the payback.

There are ways of encrypting data on a table on a per-user basis. There is encryption software out there that allows a database admin to perform actions but never be able to actually see the patient records. It's possible to remain both efficient and private in regards to patient electronic medical records.

Let's face it - the medical system needs electronic controls because of precisely the types of things you describe - doctors not being able to see all the data, or in some cases, making mistakes. Doctors are human beings just like you and me and can mistakes all the same. Adding computing into the mix allows an extra level of safeguards to prevent sloppy mistakes like the ones mentioned, like the one that killed my grandmother, and really none of that is possible without first using an EMR system, so that various pieces of software can collect and correlate data.

The data analysis on the efficacy of various procedures is already starting to be done, and already is yielding surprising results. I can't get into detail, but I would think it will be more widespread in the next decade or so and see more and more use throughout various hospital networks in the US.

One of the things in the past that traditionally acted as a barrier to analytics was really the CPU horsepower / computing costs. The past decade has yielded ridiculously large gains in terms of how much you can do computing wise. You no longer need a supercomputer to analyze and correlate data and can do the same nowadays with 1/100th the cost of what you could do 10 years ago, since chips have dropped so much in price, and since hard drives have increased in speed via SSD's. The next 10-20 years will be the golden age in terms of discovering which procedures work, which are next to useless, and which are actually detrimental, in my opinion.

Whether the public at large will be exposed to said data is another question entirely, but I would hope that the information leaks out to the public at some point so that patients have more power to decide for themselves whether to go for that elective surgery that is only 5% effective versus the one that is 75% effective and 1/10th the cost of the former.

 

[mshan]

We already have an EMR: it's the NSA!

Just give docs dedicated phone dictation lines that feed directly into NSA mainframes, let the NSA create some meta-data templates, and voila, a plethora of data for scientists to mine.





(Except, of course, that according to originally NSA whistleblowers (http://www.usatoday.com/story/news/...istleblower-nsa-officials-roundtable/2428809/), that NSA database in not even encrypted because the people in Washington who buy the systems say that no one cares about that...)

"That's the way of preventing this kind of random access by a contractor or by the FBI or any other DHS (Department of Homeland Security) or any other department of government. They couldn't go in and find anybody. You couldn't target your next-door neighbor. If you went in with his attributes, they're encrypted. ... So unless they are in the zone of suspicion, you won't see any content on anybody and you won't see any attributes in the clear. ...

It's all within our capabilities.

Drake: It's been within our capabilities for well over 12 years.

Wiebe: Bill and I worked on a government contract for a contractor not too far from here. And when we showed him the concept of how this privacy mechanism that Bill just described to you — the two degrees, the encryption and hiding of identities of innocent people — he said, "Nobody cares about that." I said, "What do you mean?"

This man was in a position to know a lot of government people in the contracting and buying of capabilities. He said. "Nobody cares about that."

 

[Brian Stirling]

By some accounts mistreatment results in the death of nearly 200,000 people every year -- two 9/11's every week.

http://www.medicalnewstoday.com/releases/11856.php

I think a good many doctors are uncomfortable with EMR because it makes tracking what the did easier and you can bet those records will be used against them in court when they're sued. There are other reasons, of course, but I think this is reason number 1.

Also, when medical records are properly computerized computers can be used to diagnose based on patient history. I'm guessing doctors are not looking forward to the day when computers do most of the diagnosis.


Brian

 

[Darwin333]

I know there are still parts of it that have not been implemented and maybe it will take years, if not decades, to see its real effect. But with the recent report of medical care rising at a slow rate it would at least suggest that, if nothing else, hasn't had a negative affect. I know individuals will talk about their premiums going up, but thats not a real indicator, that has more to do with the company you work for. My company has to follow the same rules and I pay $20 a week for me and my kids for medical and dental and 90/10 coverage and no deductible.
And clearly it hasn't brought the economy to its knees. So could Obamacare be a long term success? Does it seem to be headed that way?

If you pay $20 a week then that is useless info because your employer must be paying the vast majority of the cost. I easily pay 10 times that.

 

[Darwin333]

By some accounts mistreatment results in the death of nearly 200,000 people every year -- two 9/11's every week.

http://www.medicalnewstoday.com/releases/11856.php

I think a good many doctors are uncomfortable with EMR because it makes tracking what the did easier and you can bet those records will be used against them in court when they're sued. There are other reasons, of course, but I think this is reason number 1.

Also, when medical records are properly computerized computers can be used to diagnose based on patient history. I'm guessing doctors are not looking forward to the day when computers do most of the diagnosis.


Brian

I used to be all for the computerization of medical records but at the time I didn't realize the obvious, after the NSA's bullshit I have zero faith in my medical records remaining private.

 

[Darwin333]

Well, let's assume "wing nuts" in Congress did write some good laws that improved on the legislation that's trying to be implemented today. We must also assume that they passed the Senate and Obama did not veto them. BTW, these are very legitimate concerns, but we must make assumptions for the sake of argument.

Right now, with no authority to do so, the executive branch, with the apparent blessing of Congress is delaying and postponing portions of the massive healthcare bill. They are selectively enforcing some provisions and selectively postponing some provisions with no legal authority to do so. Nowhere in the bill (that I know of) is there a provision for implementing it in a selective fashion. No outcry from the left, too little outcry from the right, no outcry from the media and yes, that last one is a joke.

So, assuming "wing nuts" did wonderful things, what would ensure the implementation of said wonderful things? We are experiencing first hand a government that no longer answers to anyone but themselves. It is a far bigger issue than healthcare, immigration reform, drones and new puppies in the White House to name just a few of the topics of the day.

While the public is distracted with the promise of shiny new toys, our representative form of government is being further eroded and I would make the argument that it's happening at a breathtaking pace. It may be time to decide what is and what isn't important.

Agreed but you left out the part where they also select a group of uber elite private citizens whom they and they alone, with no legal authority whatsoever, deem to be above black letter law.