Promises, promises . . .

Or should I say "excuses, excuses?"

I've been slammed at work lately. I want to write, but I've been working, and working, and working . . . I can't complain too loudly though--I have a friend who is a resident working 80 hour weeks right now . . . That man is TIRED!

As difficult as it is, I have a lot to say . . . and I will say it. But I'm a little nervous about writing here. The economy is scary (to say the least), and I don't want to do anything to jeopardize my current job.

My kids are visiting this weekend, but following this weekend I'll begin to write more. Maybe someone will "hear" what I'm saying . . .

Focus

Oh Lord, tell me I'm not "sleeping with the enemy . . ."

We (insurers) focus on patients (our primary customers) . . . and there is nothing wrong with that. But we need a broader focus. We need relationships with our members and our providers that are equal in nature.

We do a disservice to our customers (patients) by not having good relationships with health care providers.

In my humble opinion, this is more than cat-herding.

To read:

UnitedHealth and IBM Test Health Care Plan
UnitedHealth Leading the Way on the Medical Home?
United HealthCare; Still the Scum of the Earth

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The business of herding cats

I'm a novice cat herder.

Most of the cats I'm trying to herd are larger than me. Much larger. OK, we all know how much cats love to be herded . . . try herding the big ones. Exactly. Success isn't easy.

Where am I going with this? Well, as you know already, I'm a cog. Now you know that I'm a cat-herding cog. I think those of you in health care can picture this . . . a cog attempting to herd cats.

And cats have ideas, if you know what I mean. LOTS of ideas. Sometimes cats have good ideas (like sleeping in a warm spot), but some of their ideas are not so good (sleeping in a warm spot which happens to be under the hood of a car). OK, none of my cats' ideas are THAT bad, but still. The real problem is the problem of all cat herders--ALL of my cats seem to think that they are in charge. ALL of them. And they all want to go with their own ideas, but their ideas aren't necessarily compatible. Cats!

OK, enough about cats . . .

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I've noticed a few things about people, and I'm taking notes. Some of the most successful people I know are also some of the most humble.

A year ago, I sat down and created a strategic plan for myself and my career path. I wanted to move forward, but I wasn't sure how to go about it. Thus, I began with a list of people whom I know and admire and asked them for advice. The kindest and most helpful person also happened to be the most successful person on my list. He is the retired CFO of a large, publicly traded company. This man reviewed my resume, asked me lots of questions, and gave me advice--and he spent a lot of time doing this. He also contacted a buddy of his who is the retired CEO of another large, publicly traded company. Both of these men were very humble about their careers and offered me useful advice. They both contacted other folks within their circles of influence in order to aid me--a cog! But they didn't treat me like a cog. The treated me like a student or a novice . . .

Other people on my list weren't at all interested in helping me. They were too busy, too important, too whatever (too busy being cats?). And some of them had been cogs like me in their recent past. But I learned from these folks as well--they just weren't aware of what they were teaching me.

I don't know where I'll go from here. Perhaps I'll always be a cog. Actually, I know I'll always be a cog, no matter where I end up--cogs are useful. But I'll be a humble cog, a cog willing to help another cog move forward . . .

Maybe some day I'll be able to help another cog learn how to herd cats.

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Setting up a new blog . . .

. . . is a pain in the ass. Seriously.

I love to write, and I have lots of ideas--I've missed blogging! But first, I need to set this thing up . . . I have to admit that it is much easier now than it was in 2005 when I started the other blog. MUCH easier. In a way, it's more difficult though because I know what I need to do . . . back then I was learning along the way (on-the-blog training?).

So instead of writing, I'm adding links and a site meter . . . I still need to be added to the blog directories and ranking sites.

I've also noticed that some of the blogs from the past that focused on the business side of health care are no longer in existence . . . The business side isn't nearly as interesting, for sure. But it is important . . .

After setting up the blog, I plan to move any relevant posts from the old blog over here, so if you see something that looks familiar, I promise that it wasn't plagiarized. Then I'll start writing some new material. One of the first topics I will write about is health care/health insurance fraud. Later, I'll share some "patient" stories. Yes, I have patient stories too, and I need to be mindful of HIPAA when I write them. You've read what the doctors say about patient interactions . . . it doesn't stop there. All of that stuff is touched on the insurance side as well--think underwriting, claims, etc.

So, here we go again!

Introduction: A Humble Beginning . . .

Once upon a time, I wrote a patient blog, participated in medical blog carnivals, and followed multiple medical and health care related blogs. I wanted to go to med school, and had an interest in all things medical.

I removed my patient blog after witnessing the impact a blog can have on one's personal and professional lives--we are never truly anonymous (some of you may remember Flea, the doctor whose blog was disclosed in a malpractice suit).

I never lost my interest in health care and all things (most things?) medical . . . I've been wanting to blog again, but I've been worried about the many ways my writing could potentially impact me or my current employer. But I have a voice, and I want it to be heard.

Who am I? I am a patient, I am the parent or child of other patients. I am also a business professional in health care--working on the health insurance side. I am a minuscule cog in a very large wheel, but I'm doing everything I can to "fix things that are broken" on my side of the fence.

Electronic Medical Records: a door to health care fraud?

A week or so ago at my workplace, we had a guest speaker at our weekly staff meeting. The topic? Health care fraud. It was interesting to learn all the different ways in which people commit health care fraud--fascinating even (you would be amazed by some of the things people do).

Yesterday, I received the following letter from my doctor:

Dear patient,

We are writing to inform you that our computer system was attacked by a computer virus on November 8, 2007. We believe that the purpose of the virus was to use our server to send out e-mails (spam). Our research done on this type of virus indicates this is the case. However, we cannot be sure that patient data was not also accessed. Our server does not contain any credit card information.

The security was breached after an update from our Electronic Medical Record was installed. This update opened up access to the server. We have corrected the problem and reconfigured the server to prevent this from happening again. We are taking every step possible to ensure that your health and personal information remains confidential and secure.

Although at this time it does not seem likely the intruders were after the data on our server, it would be prudent to order a free copy of your credit report to check for unusual or unauthorized transactions. . . . It is also a good idea to watch your insurance EOBs (the forms that explain what the insurance company was charged for and what they are paying) to ensure that you are only being charged for legitimate visits. . . .

Thank you for your understanding regarding this unfortunate hazard of our computer age. Our ultimate responsibility is to provide you with the best health care possible, which would not be possible without taking advantage of an Electronic Medical Record. We are confident in our security updates and hope never to have another such incident.

With our sincerest apologies,

All of us at [my doctor's office]

Wow. So, let's start with this statement:

We believe that the purpose of the virus was to use our server to send out e-mails (spam).

Most of us are familiar with these types of viruses, but they apparently didn't get the virus by opening an infected email. The got the virus while updating their EMR system:

The security was breached after an update from our Electronic Medical Record was installed. This update opened up access to the server.

Nice. They also admit to being unsure if patient records were accessed. This doesn't sound like an email/spam virus to me . . .

Let's move on to this statement:

Although at this time, it does not seem likely the intruders were after the data on our server . . .

Oh please. It doesn't seem likely? Should we discuss what the worst case scenario would look like?

And then:

It is also a good idea to watch your insurance EOBs (the forms that explain what the insurance company was charged for and what they are paying) to ensure that you are only being charged for legitimate visits. . . .

Give me a friggin' break. How about advising patients to NOTIFY THEIR INSURANCE COMPANIES to prevent health care fraud from occurring in the first place. Duh. It's also much easier to notify the insurance company than try to watch every EOB that comes your way. Trust me, insurance companies have entire departments devoted to this stuff. Sure, notify the FTC and the credit bureaus (identity theft really sucks--trust me, I know from first hand experience), but I think it's more likely that someone will sell the information to folks planning to commit health care fraud--it's big business these days.

And finally:

Our ultimate responsibility is to provide you with the best health care possible, which would not be possible without taking advantage of an Electronic Medical Record.

Really? Dr. Dino, do you have anything to say about this?

I've thought long and hard about whether an EMR is a worthwhile investment for me at this stage of my life and the life of my practice. Over and over again, I find that each pro-EMR argument is based on assumptions that do not apply to me. . . . But so far, no one has been able to credibly show me that the benefits of adopting this new technology outweigh the considerable disadvantages, starting with the initial monetary outlay, when addressed in the specific context of my practice. Read more (it's definitely worth it) . . .

So tomorrow, I'll be handing a copy of this letter to my insurer. Then my doctor will be getting a phone call from me asking for additional information . . .

From a patient's perspective, I do understand the benefits of EMR--I realized them first hand after suffering an injury requiring several specialists within the same medical system. And a large medical system normally has the technical staff available to guard against this type of intrusion. A smaller office, such as my doctor's office, doesn't have the resources for the information security needed to guard their patients' records. My doctor's office is very similar to Dr. Dino's office--there are only two doctors (no nurses, medical assistants, or physician's assistants). The doctors are wonderful, and they don't hurry through appointments. But they just don't have the resources available to guard the information held in an EMR.

What are your thoughts?

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Original comments:

Chris said...

Ha, those evil insurance companies! I think we are more in danger of petty smash and grab identity theft from the electronic medical records than the original fear: insurance companies would tap in and deny coverage to those at risk. Like 1.1 million other veterans, I had my medical/identity data stolen from the VA and got a letter similar to yours. Stay cool! -C

Acceptable Risk

I found this on Wired:

"After sorting through red tape, a California hospital has fired nine employees who in April either took or looked at camera-phone photos of a patient's X-ray. Meanwhile, at least three other hospitals across the country are struggling with similar problems." Read more . . .

Hmmm, I think I've seen a few of these in various blogs . . . While I love the medical blogs, I don't want to see anyone lose a job over an x-ray posted online. I know that some folks are tired of hearing about Flea's debacle, and many are worked up over all of the blogs that have disappeared, but this needs to be discussed. We all need to understand what is acceptable to blog about and still keep our jobs. We need to know what the consequences will be if we step over the line. From there, we can decide what our own "acceptable risk" is--this is something we have to decide for ourselves.

To read:
Introduction to Risk Management and Insurance (8th Edition)

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