Repairing the Healthcare System

Medicine Is A Calling: Not A Business

  Stanley Feld M.D.,FACP,MACE

I am pleased that I am able to stimulate comments from physicians in various parts of the country. Please keep the comments coming.

Many of these physicians feel trapped by the bureaucracy and medical care policies that are restricting them from developing a real physician patient relationship. The physician patient relationship is precious to the practice of medicine.

The positive physician patient relationship enables an enhanced therapeutic effect.

As stated by a previous physician writer in my last blog,

The patient has a complaint, the physician listens (or not), performs an examination (or not) makes a decision regarding the probable cause of the complaint, writes a prescription (or two, or three), offers some instructions regarding what the patient should be doing to help himself (or herself), says goodbye and asks that the patient return at some future date for reassessment (or not).”

Physicians have been trapped into this behavior as John Goodman pointed out. The patient physician relationship has been destroyed by the dysfunctional healthcare system. Obamacare is accelerating the dysfunction in the healthcare system.

 Many tests are done for defensive medicine purposes. In fact the extrapolated cost of defensive medicine is $700 billion dollars a year.

 Physicians might even give the patient a shot of something for good measure to prevent a malpractice suit.

The government, hospitals systems, and healthcare insurance industry control the healthcare system.

These secondary stakeholders have made physicians commodities. Physicians are trapped into going through the motions. Medicine is a calling not a business. Physicians have been forced into making it a business.

Physicians are so frustrated with the system that they are joining hospital systems to rid themselves of the bureaucracy and avoid practice responsibility and malpractice suits.

The hope is that it will lead to a “happier life.” Not true.

The privileged hospital employed physicians become the designated spokesperson by the hospital administrator for the staff physicians.  They deny there is any anger or frustration toward the government, the hospital system or the healthcare insurance industry.

The rest of the physicians keep their mouth shut and trudge along angry and frustrated.

There is a mountain of pent up anger and frustration toward hospital systems by these physicians.

I received this note from another physician writer,

“Dr. Feld:

When I read your post last week “It’s All About Patients and Physicians”, I thought you were writing to me directly. I have been thinking about this for years. It is not only that software innovation in Medicine lags behind every other industry, but also the focus has not been in the correct area. As with everything else, the medical profession has given control to others.” 

This physician is absolutely correct. In a country whose administration and congress is run by lobbyists who are not interested in patients or physicians but are more interested in protecting and furthering their clients’ vested interests the problems will not be solved.  Medicine and Surgery do not have adequate representation or resources to make their case to the public.

Perhaps it is because the AMA is too democratic or too civil. The AMA’s customers are physicians. Physicians have deserted the AMA because of lack of representation.

I think the AMA might still have a chance with some bold leadership. After all without patients or physicians you wouldn’t have need for a “healthcare system.”

 He goes on,

“Current software tools allow the development of disruptive systems that can put patients and physicians on the same side of the equation, develop networks to allow much better communications, and integrate the future of mobile devices that will transform healthcare. It should be possible to produce change in current relationships.” 

It is not only possible it is probable. I need a Posse of consumers to step out and force the secondary stakeholders to not take advantage of them. This must be a consumer driven effort.

Consumers can be organized through social networking just as Internet companies, venture capitalists and citizen expressed their voice on the Internet and stopped the two Censorship Acts (SOPA and PIPA) that were being railroaded through congress. The traditional media did not cover these two bills until the organized effort was working.

President Obama backed these bills until it was obvious to all that the anti-censorship effort expressed the will of the American people.

Patients (consumers) need leadership and innovative software to demand that they own their healthcare dollars and healthcare care decisions.

 I believe many physicians yearn for the ability to spend more time with their patients. Patients must demand it also and pressure the government to relinquish control over our healthcare system.

This writer/ physician’s note to me expresses this desire. It is an important story about the physician patient relationship’s key role in patient care.

“Let me begin with a story. I take care of an elderly man who lives in Brooklyn and suffered a stroke one year ago. At the time the patient was visiting with his son, who is a Rabbi in Chicago. The patient made an excellent recovery following high-quality rehabilitation at a Chicago hospital.

 He is a survivor of the Holocaust who lives with his wife and is generally independent. Although his walking is slow, he is able to walk utilizing a cane to a nearby synagogue for services every morning. As I was interviewing him last week, he mentioned that most of his day is spent at home with very little to do.

 He does not have television, and is not that interested in reading newspapers.

 After hearing this, I excused myself to go to my office and bring back an iPad to show him. I placed it in front of him, and logged on to a website sponsored by Yeshiva University (yutorah.org).

 I showed him that he would have access to literally thousands of lectures by leading rabbis that he could listen to on demand. His eyes widened and he looked at me with amazement. He asked me if that device needed a computer, and whether it would work in his home. He inquired about the cost.

His wife immediately told me that she wanted one (iPad) for him, and that their daughter would be calling me for the information about setting things up.”

Ninety percent of physicians would like to have time to relate to patients this way. The dysfunctional system has forced physicians to act differently.

 This patient recovered from his depression. He is thriving with the use of his innovative device (iPad).

He goes on further to say,

I cannot finish my career in Medicine without finding a way to integrate experienced people with great ideas and insight with young people who know how to create the tools to bring innovative approaches to actuality.

 I will describe the future state next. Innovative software can be built in the future state that provides patients with the tools to express their needs and for patients to accept responsibility for their care.

Consumer driven healthcare with the ideal medical savings account will be the foundation of this transformative healthcare system.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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Some Innovative Software Opportunities In Medicine.

Stanley Feld M.D.,FACP,MACE

I have pointed out that all the stakeholders are to blame for the dysfunction of the healthcare system.

 I have also explained the difference between the healthcare system and the medical care system.

In the past two weeks I have explained that both the medial care system and the healthcare system are ripe for disintermediation with innovative software just as the publishing system was dis-intermediated with amazon.com, the music industry with ITunes and the movie industry with Neflix.  

John Goodman has recently written a series of articles on how physicians are trapped by the current healthcare system.

 The core problem has developed over the last 40 years. The government and the healthcare insurance industry have created a huge payment hairball between patients and physicians.

ICD and CPT coding has created complications beyond belief for patients and physicians. The ICD 10 is more confusing that ICD 9.

ICD 9 contained 15,000 codes. ICD 10 contains 68000 codes.

Instead of closing the window for fraud and abuse it has opened it further.

The problems with coding can be dis-intermediated by innovative software with its focus on patients and physicians.

A retired physician wrote the following note to me after reading my posts about innovative software and the destruction of the patient-physician relationship. His narrative was in response to the WSJ article “Should Physicians Use Email to Communicate With Patients?”

The writer is a retired physician with 40 years of private practice experience. He has lived through the development of the dysfunction in the healthcare system.

 “Stan 

 This observation has been on my mind for a long time. The health issues in the 4th section of the WSJ today January

23,2011 caused me to put the ideas down on paper. 

 D”

 “In doctors’ offices all across the country, a scenario like this is being played out as I write these comments.

 The patient has a complaint, the physician listens (or not), performs an examination (or not) makes a decision regarding the probable cause of the complaint, writes a prescription (or two, or three), offers some instructions regarding what the patient should be doing to help himself (or herself), says goodbye and asks that the patient return at some future date for reassessment (or not).”

 This is an excellent description of the disconnect between the care of patients by physicians. Patients and physicians should have a relationship where patients are at the center of the physicians’ healthcare team. The physicians are coaches. The physicians’ team is the assistant coaches helping physicians treat patients. 

 “What happens next is where I’d like to spend a little time in this essay.

 The written prescription/s may be hand-carried to the pharmacy, the doctor may telephone the prescription/s to the pharmacy, or more commonly these days, the prescriptions may be sent on line or by fax, with the doctor’s assistant doing the sending.

The government is now paying an incentive bonus to the physicians for e-prescriptions. Unfortunately 60% of physicians’ offices cannot afford the software.

 This is a place for a fully functional ideal electronic medical record in the cloud.

 “Now here is where the situation can get dicey. Up to 20% of all those prescriptions are never picked up by the patient. After an interval, they are returned to stock in the pharmacy. It is unlikely that the doctor will be made aware that this has happened.”

 The e-prescription must be a two way street. The physician should be notified electronically by the pharmacy if a patient does not pick up a prescription.

 The physician’s office should automatically contact the patient and explain the importance of the medication.

Other results can also happen. The patient picks up some, but not all of the prescriptions because of the cost versus what he/she can afford.

In the fully functioning EMR software can be included to enable the pharmacy to inform the physician.

Or the patient picks up all of the medications ordered. Once at home, the patient may or may not take the medications as prescribed.

 The instructions from the doctor may be recalled incompletely or inaccurately.

The healthcare team can electronically reinforce instructions and goals for the medication using the Internet sites picked by the physician.

 The physician’s healthcare team must be an extension of the physician’s care.

Freestanding organizations will fail if they are not an extension of physicians’ care.

The CBO recently revealed that President Obama’s pilot studies using freestanding chronic disease management organizations have failed to lower the cost of care.

My fear is that President Obama and his healthcare administrators will conclude that chronic disease management does not lower healthcare costs.

Effective chronic disease management of diabetes can lower the complication rate by at least 50%. Decreasing complications can lower the cost of care by 80%

The medications may not be tolerated by the patient, and as a consequence, he/she may elect to discontinue one or more of them, or may elect to take them in some manner other than as directed by the doctor.

The patient may not notify his physician of his difficulty taking the medication.

Social networking between physicians and patients and patients in that physicians practice could solve this problem.  

Patients understand that most cognitive physicians are reimbursed for coded procedures. Advice over the telephone or email is not reimbursed. A mechanism for reimbursement must be developed for using social networking.

The medications may prove effective in alleviating the problem that caused the patient to see their physician in the first place, or they may not.

Most of the events described will not be known to the patient’s physician until the patient is next seen in the office, and maybe not even then.

E-mail could have malpractice liability in the current malpractice environment. This is one more reason Tort reform is essential.

In a perfect world, a lot of the issues raised above could be made better by a few simple moves. The pharmacy could make the physician’s office aware that the prescriptions were never picked up.

Someone in the physician’s office could call or email the patient 3-4 days after the visit, and inquire whether the patient is taking the medication,

Reinforcing the physician’s instructions, and inquiring whether the medications are helping the patient, asking if there have been any problems arising from the use of the medication, and passing what is learned back to the physician.

 The reinforcement of the instructions can be very helpful, and the awareness of issues relating to the medication can lead to more timely resolution of problems the patient is experiencing.

It has always seemed to this writer that the doctor-patient relationship would be well served if we all started to use what I call “The Doctor Phil Question”, which goes like this: “How’s that working out for you?” 

It is all about patients’ responsibility for their healthcare and their healthcare dollar. It is about consumer driven healthcare and the patient physician relationship. 

 As long as the government and the healthcare insurance industry continues to drive a wedge between the patient and physician the cost of healthcare will continue to rise.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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Holy Cow!! A MakerBot Thing-O-Matic

 Stanley Feld M.D.,FACP,MACE

 Last week I flew to New York City to speak to a group of venture capitalists about my ideas on how to Repair the Healthcare System from a physicians point of view.

All of the software innovation in healthcare comes from software engineers who are influenced by secondary stakeholders that are trying to increase their profit from the healthcare system and not by physicians who have been in the trenches practicing medicine day after day. 

 My son, Brad Feld, was in Boston involved in a project at his alumni MIT. He decided to come down to New York and sit in on my meeting. 

I love hanging out with Brad. It is always a learning experience for me. My readers have guessed by now that I love to learn and especially from my son. I especially love to learn about the potential of the future.  It stimulates me to think.

Two months ago Brad sent me a MakerBot Thing-O-Matic. MakerBot is a company in which he and his venture capital firm Foundry Group invested. The MakerBot Cave is in Brooklyn, N.Y.

 My MakerBot Thing-O-Matic came in five boxes weighing 25 pounds. I opened the boxes and it looked like at least a million pieces (o.k. at least a half million).

It reminded me of the time I was a medical student. My roommate’s father bought him a HealthKit HiFi. I helped him put it together.

It took us months to finish. When we finished the HealthKit I thought it was going to explode when we plugged it in. It worked to our joy!!.

A MakerBot Thing-O-Matic is a 3D printer. I saw it with Brad at CES in 2011. He invested in it then.

 

I told Brad I thought he lost his mind. I thought the MakerBot was just a toy making little kids’ toys.

Construction of my MakerBot Thing-O-Matic looks like a 10-12 hour project with a lot of software interaction.

After our N.Y.C meeting he took me to the Bot Cave in Brooklyn. Manufacturing things in Brooklyn has a nice ring to it.

As soon as I walked into the Cave I decided Brad once again made a brilliant decision.

The first thing that impressed me was the number of young (25-40) people working in the Cave (about 100).

 If President Obama wants to create jobs he should visit the Bot Cave in Brooklyn. He would learn a thing or two.

I was told the next iteration of the MakerBot would be pre-built.

After watching these kids build them I got pumped to get home and build my MakerBot. I was also promised a personal assistant if I got stuck.

 3 dimensional printing is beyond toys. There is a web site called Thing-O-Matic that lets users post their creations for other users. The MakerBot community has become an organic social network.

 For example, someone designed a wall coat hook that is being reproduced all over the country. The Bot Cave had coats hanging on them everywhere.

I have been looking for flat electric outlet covers without curves. They have been impossible to find. All I have to do is scan my design into the computer, size it and print out a very sturdy electric outlet plate.

 Three weeks ago I needed a replacement plastic gear. I had to buy all the parts for the machine just to get one part. Now (after I put my MakerBot Thing-O-Matic together) I will be able to reproduce any plastic part I want. The practical potential for 3D dimensional printing is infinite.

 How does it work? It is all about software innovation. Your smartphone takes multiple pictures of an item. You import the pictures to the computer software. Maker Bot recommends multiple pictures at many angles to get the proportions perfect. The pictures are transformed into 3 dimensional co-ordinates. You hit go button and the machine melts the right amount of plastic at the weight you specify and extrudes your part or model in 3 dimensions.

Who would have thought there were people that smart to create an appliance like this machine for consumers.

The more intriguing thing is I could not understand the MakerBot’s potential until now. Brad understood it as soon as he saw it.

The reason is clear. He could visualize MakerBot’s potential. I predict everyone will have a MakerBot Thing-O-Matic in 10 years just like everyone has a smartphone after 4 years.

I have a gut feeling “we ain’t seen nothin yet.”

Everything will be consumer driven. Even healthcare will be consumer driven.

 The MakerBot people gave me an iridescent expandable plastic bracelet for my wife.

It reminded me of the bracelet Hank Rearden in Atlas Shrugged. Hank Rearden gave to his wife a bracelet made out of Reardon steel after it was invented.

 She did not understand its significance. His wife traded it with Dagny Taggatt, the heroine, for a diamond bracelet.

The future is in 3 D printing.

 Brad thanks for taking me to the Brooklyn Maker Bot Cave and opening my eyes again.

 

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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Who Said Consumer Driven Healthcare Cannot Be A Market Force?

 

Stanley Feld M.D.,FACP,MACE

I love Costco. Its prices are great and its selection is abundant. Last week I was dazzled by the display of megavitamins as soon as I walked into the store.

Americans want to be healthy. Few have a death wish but many (60%) are obese. Megavitamins have been touted as the instant route to healthy living. The megavitamin business has grown into a $30 billion dollar a year business.

Megavitamins have been successfully oversold.

There is no evidence that megavitamins are the route to health and healthy living.

“A national survey by the US Food and Drug Administration found that 73% of US adults were found to use dietary supplements in 2002.”

There is little good evidence to support the widespread use of dietary supplements.

The US Preventative Health Services Task Forces reviewed some of the literature on megavitamins and dietary supplements. The group stated there was insufficient evidence for or against the use of multivitamins with folic acid or antioxidants. It also stated that the use of Vitamin A, C or E did not have sufficient evidence for or against its use.

 I think these supplements could be helpful if the requisite dosage was known. There is no evidence that these dietary supplements are helpful at the present dosage. There are no scientific studies about which doses would work. There are only testimonials attesting to usefulness.

”Beware of the man with one case.”

 A friend of mine worked for thirty years proving the existence of Vitamin D deficiencies in 50% of the elderly population. It took him half that time to convince the medical population that he proved something.

 

The dosage necessary ended up being 6 times the dosage in multivitamins. Therefore USPHTF conclusions are correct with the present data. However they might have drawn their conclusions from the wrong data.

This is not an unusual occurrence in clinical medicine as I have pointed out previously. 

The American Medical Association hedged its bet by stating,

“It recommends supplements specifically for seniors who have generalized decreased food intake.”

Chances are people who are starving or dying from cancer will have a multivitamin and mineral deficiency.

The American Dietetic Association advises,

“low-dose multivitamin and mineral supplements depending on individualized dietary assessment.”

The ADA’s statement is obviously self-serving.

The American Heart Association made the only logical statement in the whole bunch.

“The AHA emphasized healthy eating patterns rather than supplementation with specific nutrients. “

The recommendations against the routine use of supplements are grounded in fairly good evidence if one believes in a methodology used by the Cochrane intervention review.

A Cochrane intervention review of 77 randomized controlled trials with 232,550 participants found no evidence to recommend antioxidant supplementation for primary or secondary prevention of mortality.^[7]. 

There is shabby evidence that cannot be generalized regarding possible harm related to the use of some supplements.

 “For example, the Alpha-Tocopherol Beta-Carotene Cancer Prevention Trial demonstrated that beta-carotene supplements increased the risk for lung cancer among male smokers.^[8]” 

At this point there is no good scientific evidence for the use of megavitamins. “People believe what they want to believe.”  The placebo phenomenon is extremely important.

The media is the message. Somehow the power of advertising has convinced the public that it is good to take megavitamins.

Costco is trying to take advantage of the hype. Consumers are driving this healthcare choice. The result is a $30 billion dollar a year business. The money is coming directly out of the consumer’s pocket. It is not included in healthcare costs.

Consumers are trying to be responsible for their health on the basis of hype. It is much easier in the mind of most to stay healthy taking a pill than do the heavy lifting required for healthy living.

Why can’t someone create an anti-obesity hype that works as well as the megavitamin hype?

Increases in obesity lead to increased Type 2 Diabetes, hypertension, hyperlipidemia and the resulting Diabetic complications of stroke, heart attack, blindness, amputations, chronic renal disease and cancer.

Many schemes have been devised to decrease the increasing obesity rate. None have worked except eating less and doing more.

With the increasing obesity in children there is an increased incidence of Type 2 Diabetes in kids, teenagers and young adults.

Gastric bypass has become the rage for these young super obese people. To my dismay more and more insurance plans are paying for gastric bypass procedures. Even Medicaid is paying for the procedures.

Is the world going nuts?  I guess Medicaid’s logic is if the people become thinner it will decrease the incidence of Diabetes, decrease the complications of Diabetes and therefore decrease the cost of healthcare for these people.

To me it is like painting over rust. The rust will bleed through and the money for the paint will be spent already.

Americans do not get any help from society norms. We are flooded by manufactured foods with tons of calories and tons of salt. Mayor Bloomberg passed an educational law that fast food stores must publish calorie counts on foods.

This is helpful is the calorie count is accurate and people pay attention. 

Home cooking served in small portions is essential. The fat, calories and salt can be controlled. There is no need to have a home cooked meal anymore.

All you have to do is go to Costco or Sam’s and buy any precooked meal you want. Dinner is a 3 to 10 minute microwave pop away. Why would any busy person bother to prepare a home cooked meal? The harmful consequences prepared meals are in the distant future.

If you have dinner at a restaurant an average meal contains more calories than the average person burns in a day. My wife and I have been sharing for years.

Consumers want to be responsible but it is very difficult in the cultural milieu of our society. 

Ken Cooper M.D. created an exercise craze in the 1970’s. It has lasted until the present. He did not figure out how to get people to sustain their exercise program. He also did not figure out how to get people to decrease their intake in our sea of manufactured food and pre-cooked food.

The incidence of obesity is growing.

Most consumers are not stupid. They seek to be responsible in the easiest way possible.

Someone will come along and initiate a legitimate health craze.

The Ideal medical savings account (by providing financial incentives along with intense public education through appropriate advertising) can be as successful as the Dietary Supplement industry.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

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How Software Innovation Can Cause Creative Transformation Of The Dysfunctional Healthcare System

Stanley Feld M.D.,FACP,MACP

Joseph Schumpeter (1883-1950) begins his “The Theory of Economic Development “ with the idea of circular flow.

 “If any innovations and innovative activities are excluded you end with a “stationary state.”

Schumpeter's theory is that “the success of capitalism will lead to a form of corporatism. In turn corporatism will foster values hostile to capitalism. He contends this is especially true among “intellectuals.”

The intellectuals and the social climate must allow entrepreneurship to thrive. If not capitalism will be replaced by socialism in some form.”

 The hero of his story is the entrepreneur.

We are seeing this now as corporations are trying desperately to hold on to their power using obsolete technology and suppressing entrepreneurship with the government’s help.

“There are a couple of bills (like PROTECT IP  and  Stop Online Piracy Act) coursing through Congress that if enacted threaten the entire Internet only to protect outmoded business models of the movie and music industries.

The Internet has provided people with information, a choice and a voice. It has stimulated entrepreneurship and the current software revolution.

The government is making a big mistake in attacking freedom. I do not think it will get away with it because of the power of the Internet.

The hero of my story about "Repairing the Healthcare System" will be the software entrepreneur.

Technology has caused legacy business models to be replaced by innovative software models. These innovative software models have reduced costs and provided more choice for consumers at a cheaper price.

 Everyone agrees that healthcare costs are out of control and are unsustainable. The corporate takeover of healthcare and medical care is leading to the inability of physicians to relate to and treat patients as patients should be treated.

The healthcare system is heading toward collapse. Obamacare is hastening the collapse as President Obama tries to work his way toward a socialized medical system.

America cannot afford socialized medicine. A paradigm shift must take place. This shift will occur as a result of innovative software. The challenge is who will get there first.

Britain, Canada and Europe’s socialized medical systems are failing financially.  These countries are changing their healthcare systems from government controlled socialized systems to private systems.

Entitlement healthcare systems do not work because patients are not responsible for their healthcare dollars. Patients overuse the system because they are not responsible for payment. 

 When governments are overextended financially they restrict access to medical care.

 Secondary healthcare stakeholders are fighting to maintain the “stationary state” because they receive 90% of the healthcare dollars.

Secondary stakeholders use a hollow excuse for maintaining control over the healthcare dollars. They maintain that consumers are too stupid and too powerless to take care of themselves.

Software companies are trying to improve the healthcare system. They have failed because they are focused on the wrong customers.

Secondary stakeholders are a giant hairball between the patient/ physician relationship. This hairball must be disrupted.

Much of the software necessary to disrupt the hairball is available. It is not focused for the benefit of patients and physicians.

An innovator is going to come along and disrupt this hairball just as Steve Jobs disrupted the music industry.

Dis-intermediating software can only become viral and effective if it enhances the patient physician relationship.

Consumers are starting to realize that they must become responsible for their own medical care and control their healthcare dollars. The government is too unreliable.

Patients are the customers/consumers of heaslthcare. Consumers must learn to manage their health and medical care dollars wisely. They must be provided with education and financial incentives to become responsible for their own health and healthcare choices. 

What are the areas in which innovative software can dis-intermediate the failing structures in the healthcare system?

1. Ideal Electronic Medical Record.
2. Ideal Medical Saving Account.
3. Chronic Disease Management.
4. Tort Reform
5. Patient Education as an Extension of Physicians Care.
6. Integrated Care Between Family Practitioners and Specialists.
7. Patient Responsibility: Health and Healthcare Dollars.
8. Consumer Driven Healthcare.

No one likes to be forced to do anything. President Obama’s Healthcare Reform Act is forcing patients and physicians to do things they do not understand or do not approve of.  Americans are refusing to buy into his system.

In the words of the great singer/philosopher  Leonard Cohen, ”Everybody knows.”

 

 

 

“Over the next 10 years, the battles between incumbents and software-powered insurgents will be epic.”

A software innovator with a prepared mind between the age of 20-50 years old is going to come along and initiate a software revolution in healthcare. It will improve medical care for all. It will decrease healthcare costs and increase patient satisfaction. It will restore the patient physician relationship.

I will be happy to help anyone who will listen.

 

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

Please send the blog to a friend

Healthcare’s Impending Software Revolution

Stanley Feld M.D.,FACP,MACE

It is clear to me why the healthcare industry has not experienced the same transformation resulting from software innovation that the publishing industry, the music industry and the movie industry have experienced.

After practicing Clinical Endocrinology for 30 years as the founding partner of Endocrine Associates of Dallas P.A. and as President of the American Association of Clinical Endocrinologists, I believe I understand the reasons the healthcare industry has not be able to break through and enjoy the economies of scale offered by the software revolution.  

I have formed these opinions by dealing with local and national hospital administrators, healthcare insurance executives, pharmaceutical executives, healthcare policy wonks and government bureaucrats.

Most of these executives are focused on the wrong customer. Most are too busy trying to solidify their perceived position of power in the healthcare system.

Those executives who understand who the customer is have kept quiet in order to maintain or advance their position in various organizations.

The result is software innovators have been chasing the wrong customer. The result has been greater dysfunction in the healthcare system.

There are also many healthcare system issues making it very difficult to stay focused on the main problem.

I have been fascinated by my son Brad Feld’s insight into the software industry.  His tutoring has helped me learn how to critically think about software development and its transformational potential.

My brother, Charlie Feld, has also helped me through his insight into pattern recognition and the use of information technology to solve the problems of various industries.

I have followed the progress of medical software innovation for the last three decades. I am still far from expert but believe I have a better grasp on the problem than most.

I have a good feel for the potential offered by this software revolution for the practice of medicine and how to use it.

If the software industry understood the physician mentality and understood the real customer, the needed breakthrough could occur.

The result would be a large decrease in the cost of healthcare.

Waste, abuse and overuse would be decreased and the therapeutic effect of the patient physician relationship would be restored.

I believe the medical software is available right now. It has to be manipulated and synthesized as Steve Jobs, Jeff Bezos and Mark Zuckerberg have done in their respective software areas.

Brad is not interested in healthcare system software innovation. He dealt with physicians and dentists when he ran Feld Technologies in 1985 while a student at MIT.

He built an interoffice and intra-office network for my practice Endocrine Associates of Dallas P.A. in 1985.  He hired MIT students to write software with him and Dave Jilk.

The network these kids built was the sturdiest Medical Systems network in Dallas. The network lasted from 1985 until 2002. There are still remnants of this software in the practice today.

When he finished my software project he pledged to himself he would never deal with physicians again. He concluded that they are all a pain.

Not true. Physicians know what they want and need. They have an awesome responsibility for their patients’ lives and privacy.

Secondary stakeholders have frequently taken advantage of the medical profession and its intellectual property. Physician mistrust of secondary stakeholders is monumental. 

Much of the “data collected” from information systems has been used against them even if the data is incorrect or incorrectly interpreted.

Healthcare policy has been formulated on inaccurate data and inaccurate conclusions.

These conclusions have been used to devalue physicians and to destroy the patient physician relationship.

Healthcare software companies are paid by secondary stakeholder to create innovative software. The software companies do not realize that the real customers are patients and physicians. These companies do not understand why they cannot get patients and physicians to cooperate.

When data collected is wrong, incomplete or misunderstood physicians protest. They are ignored. The typical response is that this is the only data available.

Healthcare policy should not be formulated on the bases of false data.

 Is it any wonder that physicians are not interested in cooperating with the powers that be in the healthcare system’s use of inaccurate data?    

The medical transaction must be between the patients and physicians. All of the secondary stakeholders have jumped into the center of this transaction to control the healthcare system. The secondary stakeholders only add value at the edges of the patient physician transaction. 

Our health is our most precious asset. Americans are willing to pay as much as necessary for medical care. They want everything done especially if they are not responsible for paying for it.

If physicians do not think something should be done they can get sued. The knee jerk reaction is to do everything.

Physicians only receive between 5-10% of the healthcare dollars.  

Where is the money going? Secondary stakeholders are ripping off the healthcare system as they undermine and undervalue the patient physician relationship.

Third parties have taken control of the healthcare system. They have assumed responsibility for the healthcare of patients. They are also in the process of dictating access to care. The present increased healthcare costs are unsustainable.

All the secondary stakeholders are like a giant hairball destroying the viability of patient physician relationships.

Innovative software used properly can disassemble the elements of the hairball and drive them to the edges of the healthcare system where they belong.

Proper software innovation can accomplish the goal of decreasing costs and increasing the quality of care by restoring the patient physician relationship.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

Please send the blog to a friend 

 

 

It Is All About Patients and Physicians

Stanley Feld M.D.,FACP, MACE

Society is in the midst of an electronic revolution. Innovations in hardware and software have created greater shifts in our economy than the assembly line, mass transportation and electricity. We ain’t seen nothing yet.

The potential for economic growth as of result of this revolution is unimaginable.

Current business models have crumbled and have been replaced by software driven companies. Software driven companies are cheaper to run and have created innovative and easy to use products and services for consumers.

Marc Andreessen, founder of Netscape, has a tremendous handle on this revolutionary change. So does my son, Brad, and his good friend Fred Wilson.

Marc Andreessen wrote an excellent article in the WSJ on August 20th, 2011 entitled, ” Why Software Is Eating The World.”

“More and more major businesses and industries are being run on software and delivered as online services.”

Almost all industries have been affected. The hardware and software revolution have overturned many industry’s business models. 

Brad Feld wrote a perceptive blog today defining some of the changes to be expected in the near future. He also warned of incumbent and political abuses to the technological advances that are being made by entrepreneurs.

Even the freedom of the Internet is being threatened by a congress that does not understand its potential and is driven by vested interests, not the preservation of freedom, creativity and innovation.

My hope is Congress will be unsuccessful in restricting these freedoms. There will be many more industries that will be disrupted by innovative software in the coming decade.

“Over two billion people now use the broadband Internet, up from perhaps 50 million a decade ago.”

Marc Andreessen expects, “at least five billion people worldwide own smartphones, giving every individual with such a phone instant access to the full power of the Internet, every moment of every day.

Amazon.com is a dramatic example of a company that has used innovative software to transform an industry. Twelve years ago Borders was the king of stick and brick booksellers. Borders had an effective software book distribution system for its increasing number of bookstores.

Amazon, with software that distributed books directly to the customers ate Borders’ lunch. Borders thought on-line book sales was non strategic. “People like to touch books before they buy them.”

How wrong can one be? Using the same software Amazon now sells everything at a lower price than most retail stores and on-line companies. Its software decreases overhead and in turn consumer prices.

Consumers are not stupid. They want the best product at the lowest price. Amazon produced and consumers responded.

 Big box stick and brick retail stores that took over the local mom and pop businesses will fail unless they became hybrids.

The old business model bankrupted Borders.

Amazon didn’t stop there. Its Kindle digitized books and delivered them instantly at half the price to consumers with a greater margin for Amazon.

This demonstrates the genius of innovation. The creative uses of innovative software are staring us in the face daily.  Most industries  have a Blind Spot.

The existence of those people who want to touch the pages of books is fading fast. Jeff Bezo saw this Blind Spot.

Netflix copied Amazon with DVD movies. It destroyed Blockbuster.  Netflix then switched from physically delivering DVDs by mail to both delivering DVDs and on-line downloads.

It would have worked if they put the consumer first. Netflix infuriated  consumers with its pricing. It almost immolated itself. I do not think Netflix will recover unless consumers perceive that they are first.

Amazon, using a more sensible model, is going to take over the on-line movie business. Blockbuster, now owned by Dish network, doesn’t have a clue about the needs of consumers. 

Dish, Direct TV and Cable are trying to adjust to the rapid pace of software innovation. I do not think they can because they are bogged down in bureaucracy.

They are simply not entrepreneurial.

This brings us to Apple, Steve Jobs and the entrepreneurial spirit. Steve Jobs turned the music industry on its ear with ITunes, the smart phone industry on its ear with the IPhone and the computer industry on its ear with the IPad and the Mac Book Air.

His method was to use innovative software that made the appliance work for the consumer. He does not make the consumer suffer as Microsoft does with constant software freezes.

He kept his eye on the consumers. He put the consumer first. It served his vested interest well.

Before is died he made a statement in which he said he finally figured out television.

Google is a close second to Apple but Google is hampered by a growing bureaucracy.

“The great incumbent software companies like Oracle and Microsoft are increasingly threatened with irrelevance by new software offerings like Salesforce.com and Android (especially in a world where Google now owns a major handset maker).”

I could mention many more companies that have served as disinter mediators of incumbent businesses by software innovation. These innovations have resulted in vast improvements in value to consumers, decreased costs and economic growth.

 Why hasn’t healthcare in the U.S. been the beneficiary of this software revolution?

The reasons are clear to me having practiced Clinical Endocrinology for 30 years.

Healthcare is an industry with a gigantic Blind Spot. There is a good reason for healthcare’s Blind Spot.

Software developers in the medical space do not know who their customers are. Their customers are patients and physicians and the patient/physician relationship. The customer is not the government, the healthcare insurance industry or hospitals.

Once this is understood the software revolution in medicine will begin.  

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

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President Obama Is Destroying His Theoretical Basis For Obamacare In Order To Win Re- election.

 

 

Stanley Feld M.D., FACP,MACE

I have been speaking to many people about the hazards of Obamacare.

Many well-educated people do not understand the defects in President Obama’s Healthcare Reform law and its potential unintended consequences.

Unfortunately, many congressmen and senators do not understand the consequences of the law either.

Rather than President Obama’s Healthcare Reform law making the medical care system better it is destined to make it worse.

I have explained the reasons for these unintended consequences in past blogs.

Most people have difficulty understanding details of the law because it is poorly covered in the press in our sound bite society.

Only a small percentage of people need medical care at any one time.  To those not needing medical care the healthcare system under President Obama’s law has changed little except for higher healthcare premiums and deductibles.   

The 35-55 year olds are the group that must become aware of the changes that will result from the law. When they will need medical care our healthcare system will likely be decimated. 

Everyone is in agreement that our federal, state and local governments are bankrupt.  Everyone understands our federal government has borrowed and spent the money we should have saved to fund our future healthcare needs.

Additionally, entitlements and administrative inefficiency, waste and fraud will have intensified the problems of overspending.

Paul Krugman believes deficit spending is immaterial. He continues to insist that John Maynard Keynes was right even though he lack evidence for his conclusion. Deficit spending is immaterial until there is no one around to lend the government money.

President Obama keeps saying he is going to decrease healthcare costs with his law. His conclusion is theoretical. His conclusion defies his own government’s CBO and various experts.

President Obama’s conclusions also demonstrate his lack of understanding of the complicated defects that have accumulated over many years of adjusting to defective healthcare policy. 

Increasing bureaucratic structure and government control is at the root of the problems in the healthcare system. Increasing this structure is not the solution to the healthcare system.

President Obama is now backing off some of the draconian aspects of contaminating the theoretical basis of his Healthcare Reform Act.

The Obama administration’s surprise announcement Friday that it planned to give states broad leeway to pick the benefits offered under the federal health care law offers yet another example of a gradualist approach to carrying out its signal domestic policy achievement.

 Obamacare mandates what must be covered under the Federal Health Care Law

• Ambulatory patient services, like doctor’s visits

• Emergency services

• Hospitalization

• Maternity and newborn care

• Mental health and substance abuse services

• Prescription drugs

• Rehabilitative and habilitative services, and specialized social and medical services for people with conditions like autism and cerebral palsy

• Laboratory services

• Preventive and wellness services and chronic disease management

• Pediatric services, including oral and vision care

 

President Obama is choosing to avoid some crucial choices until well after the 2012 elections. Critics accuse the administration of political expediency. The Obama administration insists the decisions have been based on sound policy judgments.

I hope the public is not stupid enough to believe President Obama’s ploy. The public has been duped in the past. I think it is  waking up.

 In passing a good deal of the decision-making to states, the administration has guaranteed that Americans will continue to face a patchwork of state regulations that make coverage uneven and inefficient.

People in Utah and Wyoming, for example, are likely to have more limited access to expensive services now mandated in states like Massachusetts and Maryland. And consumer advocates worry that some states will limit benefits too strictly.

President Obama has taken the guts out of his law just as he previously discontinued the insurance mandate to large organizations in 2011.

 “I think what Congress had in mind was creating a uniform national level of benefits that would be available to everybody,”

President Obama is playing another trick play on the states and the American people. The net result will be more uncertainty, more unintended consequences and more deficit spending.

Let us not be fooled again. Let us wake up!

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

Please send the blog to a friend