The Red

Gotta say, this is pretty well done.

apropos...

Payment Due
For thousands of years, the struggle between rich and poor has largely taken the form of conflicts between creditors and debtors—of arguments about the rights and wrongs of interest payments, debt peonage, amnesty, repossession, restitution, the sequestering of sheep, the seizing of vineyards, and the selling of debtors’ children into slavery. By the same token, for the past five thousand years, with remarkable regularity, popular insurrections have begun the same way: with the ritual destruction of debt records—tablets, papyri, ledgers; whatever form they might have taken in any particular time and place. In the throes of the recent economic crisis, with the very defining institutions of capitalism crumbling, surveys showed that an overwhelming majority of Americans felt that the country’s banks should not be rescued—whatever the economic consequences—but that ordinary citizens stuck with bad mortgages should be bailed out. This is quite extraordinary, as Americans have, since colonial days, been the population least sympathetic to debtors. (Back then, the ears of an insolvent debtor would often be nailed to a post.) The notion of morality as a matter of paying one’s debts runs deeper in the United States than in almost any other country, which is odd, since America was settled largely by absconding debtors...

David Graeber, To have is to owe, precursor to his compelling book "Debt: the first 5,000 years."

...We need to understand what philosophers in the Middle Ages, from Italy to India to China, already understood perfectly well: Money is not a thing, and is certainly not a scarce resource. Money is a promise. And it is a promise we keep to those we value and break to those we do not. In Greece, Ireland, Portugal, and Spain, sovereign-debt default seems ever more likely. If it occurs, then what will happen? Certain promises will be kept, and others will be broken. As we learn from politicians every day, it is rarely possible to keep all promises exactly as one has made them. Today, in the United Kingdom, many politicians are saying, “I know I was elected on a solemn pledge not to raise tuition fees, but now that I’m in power I realize that was unrealistic. We will have to triple them.” What they in fact mean is, “I have decided that promises made by this government to repay bankers, at an agreed-upon interest rate, for money they fabricated, are more important than promises made to my own constituents.” And if promises made to legal abstractions are always to be given priority over promises made to what we still occasionally, whether fondly or cynically, call the people, we might well ask ourselves why our system of government is still deemed democracy.

Well worth your time. The health field connection:

Medical School Student Debt Is Skyrocketing
Megan Durisin and Max Nisen, Apr. 12, 2013

Experts are predicting a shortage of primary care doctors in the next few decades, just when Boomers will need them the most — with skyrocketing medical debt to blame.

Bloomberg's Janet Lorin reports that the median student loan debt for 2012 medical student grads has reached an astronomical $170,000. That number includes additional debt from undergrad, but does not include accrued interest. Tuition for all four years is typically more than $200,000 and can reach as high as $300,000 at some elite institutions.

All told, 2012 medical school graduates faced $1.7 billion in combined debt.

Federal Reserve Chairman Ben Bernanke even testified to Congress last year that his son, a student at Cornell's medical school, is facing $400,000 in loans.

When looking at this kind of debt, it's likely med school students will increasingly choose higher-paying specialties, leaving a shortage of primary care doctors. The Association of American Medical Colleges estimates by 2020 there wil be 45,000 too few primary care physicians. The AAMC also predicts a shortage of 46,000 surgeons and medical specialists...

Matthew Moy, a third-year medical student told Bloomberg's Lorin that he's racked up about $190,000 in debt. "When I think about it, it will keep me up at night," he said. "I’m dreading the exit interview when I will find out exactly how much I’ll have to pay back."...

The Red.


COST IS NOT THE ONLY ISSUE

Less than half of "non-poor" students arrive "proficient" in reading. I've taught at my university. I know this to be true. I'd look out over my undergrad classes sometimes and think "good grief, most of you need to re-take high school; you shouldn't even be here."

Which, I guess, makes me a "___ist" of some sort.

But, they all expected at least a "B" just for showing up. I got taken to my Sups twice over C- grades (that probably should have been "F's").

FRIDAY UPDATE.
THE POWER OF MINDFULNESS

Seven minutes and 43 seconds of beauty, at once agile and fragile.

Watch all of it. A lesson here.
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A VERY GOOD QUESTION

Why not MU for telemedicine?
May 10, 2013, Bernie Monegain, Contributing Editor

Imagine if telemedicine had the same government support that EHRs have garnered.

That’s the steep and thorny path on which Ryan Spaulding took his audience during a public policy discussion at the American Telemedicine Association’s 18th Annual International Meeting & Trade Show this past week.

Spaulding, director of telemedicine and telehealth at the University of Kansas Medical Center, titled his talk "Telehealth and Meaningful Use: Can It Be Done?" His answer: “Of course it can be done. I think the question might have been. 'How can it be done?'"

“How can we take a little more of a structured approach to not just adding current telehealth into meaningful use, but how can we create almost our own meaningful use for telehealth?” he asked. He then recommended that the ATA take a proposal to Health and Human Services Secretary Kathleen Sebelius to create a telemedicine national coordinator, who might work in tandem with the ONC chief, who oversees health IT.

Spaulding pointed out that there is no formal authority at the national level like there is for meaningful use of electronic medical records. Nor is there a roadmap or strategic plan.

File this under "Wish in one hand..."

 ...Spaulding suggested telehealth also might benefit from something akin to the Regional Extension Centers that the government established in all the states across the country to provide doctors with help selecting an EHR system, implementing it and then using it in a meaningful way, all of which leads to the Centers for Medicare & Medicaid Services' incentive payments that turn into penalties in 2015.

The centers might be operated by the Telehealth Resource Centers scattered around the country, he suggested.

"It’s something we could build on,” he said. “And, they’re already funded. So, they’re already in place.”...

I guess he didn't get The Memo. RECs are toast.
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Meaningful use might be a struggle, but it’s working for patients
Jennifer Bresnick, May 10, 2013

In a keynote presentation to the Rhode Island chapter of the American College of Physicians, Peter Basch, MD, FACP, echoed the words of National Coordinator Farzad Mostashari and told an audience of mostly paper-bound doctors that the key to successful EHR adoption was to “forget meaningful use.”  With dissatisfaction with EHRs on the rise, Basch advised physicians to put aside the all-consuming thought of quality measures and checkmarks and instead look for the patient-centric benefit, like improved communication and a more comprehensive, informed exam.

“Few doctors are finding EHRs helpful to them in their practice right now,” he said, “but meaningful use is doing something.  I know it’s hard, and I know we’re all struggling with it, but it has had a major impact on the IT marketplace, and it will eventually lead to better, safer, and more efficient care for our patients.  Part of that struggle gets in our way of seeing the little things that are happening now that our patients do notice.”

Citing an example of a last minute, end-of-the-day consult with another physician’s patient, Basch said that while it was freeing to conduct a consult after the computer had shut down, without needing to type or click during his conversation, it was only after he looked at the patient’s EHR the next day that he realized exactly how much information – including drug interaction data – he was missing without his electronic tools.  “Being able to do something as simple as discovering an allergy, even if EHRs seem like a pain, has enormous value to the patient.”

“It’s frightening to think that it’s going to take ten or twenty more years to come up to the technological standards of every other industry,” Basch commented after his address.  “That’s inexcusable.  I can do business online with my plumber!   When physicians are surveyed about why they don’t adopt an EHR, the top reason is upfront capital.  They say if they just had the money to do it, then they’d do it.  So we gave them what they want with the incentives.  We put in some rules, but we’re giving them time.”...

 Below, an ONC table I saw yesterday in a post answering the question "What is Meaningful Use?" (we're still answering that?)

Uh, OK, what happened to 2013? Just a typo, I know. "Stage 1" should say "2011-2013"
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$12.40 per page

We in da wrong bidness here.

PRESS RELEASE
April 18, 2013, 11:20 a.m. EDT
EMR Market Over $20 Billion: Report

NEW YORK, NY, Apr 18, 2013 (Marketwired via COMTEX) -- Driven by hospital IT upgrades and the lure of government incentives, the market for electronic medical records (EMR) exceeded 20 billion dollars in 2012, according to Kalorama Information. The healthcare market research publisher says vendors should see robust sales this year and next as vendors try to avoid U.S. government penalties for paper record use. The finding was made in its sixth annual report on electronic medical records (EMR) market, EMR 2013: The Market for Electronic Medical Records.

Kalorama Information's report said the EMR market reached 20.7Billion in 2012, a 15% increase from the 17.9 billion in 2011. Kalorama includes revenues for EMR/EHR systems, CPOE systems, and directly related services such as installation, training, servicing, and consulting which are key profit areas for companies but does not include hardware or other IT systems unrelated to EMR such as billing systems.

"Last year was particularly good for the EMR market," said Bruce Carlson, Publisher of Kalorama Information. "Companies improved sales to physicians, while hospitals added upgraded systems to conform with meaningful use requirements."

As part of the ARRA stimulus legislation in 2009, the federal government set aside nearly $20 billion in incentives for hospitals and physician practices adopting electronic medical records...

"As part of the ARRA stimulus legislation in 2009, the federal government set aside nearly $20 billion in incentives..."

Which, well, has now resulted in a $20 billion market. And, I need to pay $12.40 per page to understand that.

Ya learn something every day.

INTERESTING INFOGRAPHIC

Source: The Waking Dead: Dangers of Sleep Deprivation
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More to come...