What is the Feres Doctrine of Medical Malpractice?

The Feres Doctrine

A doctrine that bars claims against the federal government by members of the armed forces and their families for injuries arising from or in the course of activity incident to military service.

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https://en.wikipedia.org/wiki/Feres_v._United_States

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™  Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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LINK: http://www.msn.com/en-us/news/us/dying-us-soldier-fighting-for-the-right-to-sue-military-over-medical-malpractice/ar-AAAZ09p?li=BBnb7Kz

UPDATES

LINK: https://connectingvets.radio.com/articles/feres-doctrine-closer-being-overturned-supreme-court

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Invite Dr. Marcinko

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“Your Life, Your Choices” for Labor Day 2015

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More on End-of-Life Political Decisions from a Different Perspective – Since 2009

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]dem2

The controversial booklet Your Life, Your Choices begins by saying,

“There’s only one person who is truly qualified to tell health care providers how you feel about different kinds of health care issues—and that’s you. But, what if you get sic; or injured so severely that you can’t communicate with your doctors or family members? Have you thought about what kinds of medical care you would want? Do your loved ones and health care providers know your wishes?

Many people assume that close family members automatically know what they want. But, studies have shown that spouses guess wrong over half the time about what kinds of treatment their husbands or wives would want. You can help assure that your wishes will direct future health care.”

Contents

The booklet, initially produced by the VA Health System and now under revision, includes two areas of focus: 1] Planning for Future Medical Decisions, and 2] How to Prepare a Personalized Living Will.

Now, insofar as doctors, nurses and some other medical professionals are concerned – decisions of life, death or dismemberment are not an unusual or particularly contentious topic except for the lunatic fringes.

Yet, when taken in the context of HR-3200, they seem to be provoking wild outrage with talk of “killing grandma”, “government death squads”, etc all within the Obama Administration’s talk of healthcare reform. Still, this is not the point of my diatribe as I remain a neutral observer and pass no value judgment at this time.

What is the Point?

Just this! As a financial advisor for more than a decade, estate planning to reduce taxes, along with living wills and advanced directives are usual topics of discussion with clients. In fact, they are fairly boring and rote topics for estate planners, tax attorneys and accountants, too.

My wife and I have a living will, for example. And, although I am not sure that I could “pull her plug”; I did watch as she and her mother did so for my father-in-law [both wife and mother-in-law are Master-Degree prepared RNs]. So; why the impolite town-hall meetings and related controversy, now! Is it mere politics as usual, unusual, or is it something else?

Assessment

The onerous pages of this booklet seem to be page 21 and page 53. Take a look and decide for yourself.

Link: https://healthcarefinancials.files.wordpress.com/2009/08/your_life_your_choices.pdf

Conclusion

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Afghanistan and Iraq’s Healthcare Costs

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An Informative Infographic

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war

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Assessment

Over the next 40 years, Afghanistan and Iraq veterans will need an estimated $750 billion in healthcare, a challenge for the VA to innovate, especially when treating soldiers who grew up with the Internet.

Conclusion

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Injured War Contractors Sue Over Health Care

And … Disability Payments

By T. Christian Miller
ProPublica, September 27, 2011, 10:11 am

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Private contractors injured while working for the U.S. government in Iraq and Afghanistan filed a class action lawsuit [1] in federal court on Monday, claiming that corporations and insurance companies had unfairly denied them medical treatment and disability payments.

The Law Suit

The suit, filed in district court in Washington, D.C., claims that private contracting firms and their insurers routinely lied, cheated and threatened injured workers, while ignoring a federal law requiring compensation for such employees. Attorneys for the workers are seeking $2 billion in damages.

The Defense Base Act

The suit is largely based on the Defense Base Act, an obscure law that creates a workers-compensation system for federal contract employees working overseas. Financed by taxpayers, the system was rarely used until the wars in Iraq and Afghanistan, the most privatized conflicts in American history.

Hundreds of thousands of civilians working for federal contractors have been deployed to war zones to deliver mail, cook meals and act as security guards for U.S. soldiers and diplomats. As of June 2011, more than 53,000 civilians have filed claims for injuries in the war zones. Almost 2,500 contract employees have been killed, according to figures [2] kept by the Department of Labor, which oversees the system.

An investigation by ProPublica, the Los Angeles Times and ABC’s 20/20 [3] into the Defense Base Act system found major flaws, including private contractors left without medical care and lax federal oversight. Some Afghan, Iraqi and other foreign workers for U.S. companies were provided with no care at all.

Assessment

The lawsuit, believed to be the first of its kind, charges that major insurance corporations such as AIG and large federal contractors such as Houston-based KBR deliberately flouted the law, thereby defrauding taxpayers and boosting their profits. In interviews and at congressional hearings, AIG and KBR have denied such allegations and said they fully complied with the law. They blamed problems in the delivery of care and benefits on the chaos of the war zones.

Conclusion

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What is Post-Traumatic Stress Disorder [PTSD]?

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Research indicates early intervention after a traumatic event can reduce the symptoms of post-traumatic stress disorder (PTSD).

That’s why the more we know about PTSD, the more effective we can be as medical professionals and social workers to help people overcome and cope with this mental health condition.

Brought to you by www.msw.usc.edu 

Conclusion

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About the VA’s “Blue Button” eHR Initiative

The  Blue Button Initiative

By Staff Reporters

On August 2, 2010, President Obama announced the “Blue Button” capability that allows Veterans to download their personal health information from their My HealtheVet account. VA developed the Blue Button in collaboration with the Centers for Medicare and Medicaid Services (CMS), and the Department of Defense, along with the Markle Foundation’s Consumer Engagement Workgroup.

My HealtheVet and the VA Blue Button

The My HealtheVet Personal Health Record (PHR) is comprised of self-entered health metrics (blood pressure, weight, heart rate, etc.), emergency contact information, test results, family health history, military health history, and other health related information. The Blue Button extract that Veterans can download is a so-called “ASCII text file”, the easiest and simplest electronic text format (see sample files: all data, by data class, or by date range).

VA Blue Button files can be printed, or saved on computers and portable storage devices. Having control of this information enables Veterans to share this data with health care providers, caregivers, or people they trust. On October 7, 2010, VA and CMS officially announced the VA Blue Button download feature in a presentation by VA Chief Technology Officer, Dr. Peter Levin, at the Health 2.0 conference in San Francisco. The initiative was launched in collaboration with the White House, the U.S. Chief Technology Officer Aneesh Chopra, and the Department of Health and Human Services Chief Technology Officer, Todd Park.

The VA Blue Button Was Upgraded to Empower Veterans to Manage Their Health Care

With the January 2011 release of the VA Blue Button, registered users of My HealtheVetcan now download a single file that includes these new features:

  • VA Appointments (past and future) *
  • Self-entered health care providers, treatment facilities and health insurance information
  • Ability to customize the Blue Button download based on topics and dates

* Veterans must be in-person authenticated to access VA Appointments.

Assessment

So, give em’ a click and tell us what you think?

http://www.va.gov/BLUEBUTTON/index.asp

Conclusion

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On Military Brain Injury Treatment

Leader Steps Down Abruptly

By T. Christian Miller, ProPublica, and Daniel Zwerdling, NPR – June 23, 2010 6:33 pm EDT

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WASHINGTON, D.C.–The leader of the Pentagon’s premiere program for treatment and research into brain injury and post traumatic stress disorders has unexpectedly stepped down from her post, according to senior medical and congressional officials.

Brig. Gen. Loree Sutton told staff members at the Defense Centers of Excellence [1], or DCOE, on Monday that she was giving up her position as director. Sutton, who launched the center in November 2007, had been expected to retire next year, officials with knowledge of the situation said. The center has not publicly announced her leaving.

Tell Us Your Story [2]

Did you or a loved one suffer a traumatic brain injury while serving? ProPublica and NPR want to hear your story. Tell us about your experiences with TBI. [2]

Sudden Departure

Sutton’s departure follows criticism in Congress [3] over the performance of the center and in recent reports [4] by NPR and ProPublica that the military is failing to diagnose and treat soldiers suffering from so-called mild traumatic brain injuries, also called concussions.

It comes just as the Pentagon prepares to open a new, multimillion-dollar showcase treatment facility outside Washington, D.C., for troops with brain injuries [5] and post traumatic stress disorder, often referred to as the signature wounds of the wars in Iraq and Afghanistan.

Late Wednesday, in a sign of disarray within the program, Sutton cancelled a scheduled appearance at the opening of the National Intrepid Center of Excellence [6], a gleaming new facility of waving glass and futuristic virtual reality treatment rooms in Bethesda.

“The war in Iraq and Afghanistan could end tomorrow; our mission to restore health, hope and humanity will endure for decades,” Sutton wrote in her farewell message [7]. “We simply must uphold our commitment to all who have borne the burdens of war on our behalf.”

Sutton did not respond to requests for comment. Her replacement, U.S. Army Col. Bob Saum, also declined to comment.

Adult-Resources

DCOE

Cathy Haight, the acting spokeswoman for DCOE, said Sutton’s departure, though apparently well ahead of schedule, was part of a routine command rotation. Haight said Sutton decided to leave after turning down the Army’s offer to take a new position overseeing the military medical system in Europe.

“If a general officer declines (a new position)…they are in a transition to retire,” Haight said.

In recent months, legislators have questioned Sutton’s ability to carry out the mission of the centers, which is to catalyze research and treatment across the military for soldiers returning with brain injuries and psychological wounds.

Congress directed the military in 2008 to create the brain injury center and other facilities for wounded soldiers. At an April hearing [8] of a House Armed Services subcommittee, Rep. Susan Davis [9], D-Calif., said that the center had failed to carry out its role.

“The Defense Center of Excellence, while having achieved some notable small scale successes, has not inspired great confidence or enthusiasm thus far. The great hope that it would serve as an information clearinghouse has not yet materialized,” Davis said.

“The center has also made some serious management missteps that call into question its ability to properly administer such a large and important function,” Davis continued.

Sudden Scrutiny

Scrutiny of Sutton rose another notch earlier this month, when NPR and ProPublica reported on the military’s problems in handling soldiers with mild traumatic brain injuries. Such injuries leave no visible scars, but can cause lasting mental and physical difficulties.

Military statistics show that about 115,000 troops have suffered such injuries since 2002, but in interviews, Army experts acknowledged the true toll may be far higher. Unpublished research we reviewed suggests that tens of thousands of soldiers may have gone undiagnosed. Our reporting also showed that even when soldiers were diagnosed, at one of America’s largest Army bases, they have had to fight to receive appropriate treatment [10].

Veterans’ Shocked

Still, some veterans’ advocates were shocked and saddened that Sutton was leaving. They said she had been a forceful, visible advocate for wounded troops and their families who had never received the full support of the military’s medical establishment.

Assessment

Critics of the military’s health system have noted a power vaccum at the top of the military medical structure. Four people in just over three years have rotated through the Pentagon’s top health policy position, the assistant secretary of defense for health affairs.

“She was always there for the troops,” said one veterans’ advocate, who did not want to be named for fear of criticizing the military. “She’s become the scapegoat.”

In an April interview with NPR and ProPublica, Sutton shrugged off the criticism. “Leading change,” she said, “is a journey not for the faint of heart.”

“We are very proud of the team that we have built, the concept in terms of the center of centers, the network of networks,” she said. “Are we anywhere close to where we want and need to be? No. Of course not.”

Link: http://www.propublica.org/feature/leader-of-militarys-program-to-treat-brain-injuries-steps-down-abruptly

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On American Health Care and Financial Services Competitiveness

A MEMORIAL DAY OPINION – EDITORIAL

[Innovation – Not Nationalization – Can Again Lead]

By Dr. David Edward Marcinko; FACFAS, MBA, CPHQ, CMP™

[Publisher-in-Chief]

By Hope Rachel Hetico; RN, MHA, CPHQ, CMP™

[Managing Editor]

Ann Miller; RN, MHA

[Executive-Director]

American Flag

On this 2010 Memorial Day weekend, please allow us to directly reflect for a moment on the decline of the healthcare, banking and financial services industry in America. And; then somewhat indirectly comment on the hopeful emergence of the web 2.0 phenomena of which we all are a part. The competitive applicability to these sectors should be appreciated by the insightful ME-P reader.

Collapse of Command and Control Monopolies and Oligarchies   

Old monopolies everywhere are crumbling because of tougher new competitors and the transparency wrought by electronic connectedness. For example, our old newspaper has to compete with the internet, your electric utility company battles low-cost local start-ups, telephone companies must begin installing fiber optic lines to fend off cable companies; and RIAs and fiduciary focused financial advisors [FAs] will supplant BDs and stock brokers in the financial services sector.

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cmp-logo

The airline industry collapsed a few years ago, the banking industry has just collapsed, and the auto industry is recovering as we pen this post. [We have a particular affinity for the auto sector however, as the son of a UAW member and step-daughter of Michiganders]. Regardless, the rush to more intense competition cannot be stopped. As a doctor, FA or other business competitor; you either keep pace or get crushed by quasi-oligarchic organizations like the American Medical Association [AMA], American Podiatric Medical Association [FPMA], American Dental Association [ADA], American Osteopathic Medical Association AOMA], Financial Planning Association [FPA], Certified Financial Planner Board of Standards [CFP BoS], College for Financial Planning [CFP] or the National Association of Personal Financial Advisors [NAPFA], etc. What have they, and Wall Street, done for you … lately? Scandal, taint, doubt, lost-credibility, a business-as-usual ennui, lethargy and ruin! Enter www.Sermo.com

Link: https://healthcarefinancials.wordpress.com/2009/04/19/calling-for-cfp%c2%ae-fiduciary-status-real-education-and-higher-duty/#comment-4136

Health Insurance Companies

In the last-generation of health insurance companies and related fraternal medical organizations, patients exercised great control over physician selection, had quicker access to specialists and encountered fewer restrictions on care. The reverse was true with financial services. But, because of advancing technology, aging demographics, intense R&D, global manufacturing, and escalating domestic HR costs – competitive market forces against traditional and structured staff model managed care companies – many industry analysts [like us] predicted growth would decline [Yes, greed was also involved as healthcare was presumed a recession-proof sector; and didn’t we all own behemoth big-pharma and HMO stocks in our 401-K, and 403-B plans]? But now, many former stock-brokers and FAs are going rogue; er – independent!

“Although inefficiencies in any business often open up in the short term, and can be greatly exploited by creative and visionary entrepreneurs – as in most business structures – market forces will prevail in the long run”.

Leo F. Mullin, MBA

[Former CEO – Delta Airlines]Shadows

Next-Gen with “Fly”

Fortunately, a new generation of enlightened physician and FA entrepreneurs is coming “out-of-the-shadows” as new-wave web 2.0 corporations and RIAs are becoming more flexible, competitive and market responsive. Simultaneously, monolithic and collectivist political ideas keep trying to regulate the medical and financial services workplace with rules, regulations and contracts to control entire populations. Yet, in the new healthcare economy, this new generation of doctors and FAs with “fly,” is headed toward more competition; not less – with more collaboration with patients and clients – regaining self autonomy.

Physician and FA Advocates

Meanwhile, as medical professionals, FAs and patient advocates, we must all choose between staying flexible to ride out tough times – or – adopting a hard, brittle line that will crack under the pressure of competition. We know where we stand at the ME-P, do you?

Flexibility and Virtual Reality

In recent years, many large corporations and top-down business models were not market responsive and change was not inherent in their DNA. These traditional organizations represented a rigid or “used-to-be” mentality, not a flexible or “wanna-be” mindset; according to business columnist Alan Webber. Some financial advisory corporations, and today’s emerging health 2.0 initiatives, may possess the market nimbleness that cannot be recreated in a controlled or collectivist [nationalistic] environment. And so, going forward, it is not difficult to imagine the following new rules for the new financial and virtual medical ecosystem.

[A] Rule No. 1

Forget about “SEC suitability and FINRA rules”, large office suites, surgery centers, fancy equipment, larger hospitals and the bricks and mortar that comprised traditional medical practices or financial product delivery systems. One doctor or niche focused FA with a great idea, good bedside manners or competitive advantage, can outfox a slew of public servants, the AMA, SEC, ADA or FINRA “faux copy-cat examiners”, while still serving the public – and patients – and making money. It’s now a unit-of-one economy where “Me Inc.”, is the standard. Physicians and FAs must maneuver for advantages that boost their standing and credibility among patients, peers, payers, customers and clients. Examples include patient satisfaction surveys; outcomes research analysis, evidence-based-medicine, physician economics credentialing and true integrated fiduciary-focused financial planning.

However, we should also realize the power of networking, vertical integration and the establishment of virtual RIAs or medical practices, which come together to treat a patient, or help a client, and then disband when a successful outcome is achieved. Job security is earned with more successful outcomes; not necessarily a degree, automatic AUMs, certifications or onsite presence. In fact, some competition experts, like Shirley Svorny PhD, a professor of economics and chair of the Department of Economics at California State University, wonder if a medical degree is a barrier – rather than enabler – of affordable healthcare.

Link: https://healthcarefinancials.wordpress.com/2009/01/08/medical-licensing-obstacle-to-affordable-quality-care

Others even presume the establishment of virtual medical schools and hospitals, where students and doctors learn and practice their art on cyber-entities that look and feel like real patients, but are generated electronically through the wonders of virtual reality units. The same can be said for the financial services industry, although much farther down-line given its current slow rate of real education and quasi-professional acceptance.

[B] Rule No. 2

Challenge conventional wisdom, think outside the traditional box, recapture your dreams and ambitions, disregard conventional gurus and work harder than you have ever worked before. Remember the old saying, “if everyone is thinking alike, then nobody is thinking”. Do collective-nistas and nationalized healthcare advocates react rationally; or irrationally? [THINK: Wall Street, medical unions]

[C] Rule No 3

Differentiate yourself among your healthcare and financial advisory peers. Do or learn something new and unknown by your competitors. Market your accomplishments and let the world know. Be a non-conformist. Conformity is an operational standard and a straitjacket on creativity. Doctors and FAs should create and innovate, not blindly follow organization or political “union” leaders [shop stewards, BDs, etc] into oblivion.

[D] Rule No 4

Realize that the present situation is not necessarily the future. Attempt to see the future and discern your place in it. Master the art of the quick change with fast but informed decision making. Do what you love, disregard what you don’t, and let the fates have their way with you. Then, decide for yourself if you are of this ilk – and adhere to any of the above rules? Or, just become an employed [government, BD] doctor or FA shill. Just remember that the political party, or monopoly that can give you a job, can also take it away [THINK: LB, ML, Wachovia, national healthcare, etc].

CP 1

Memorial Day Considerations

Finally, on this Memorial Day weekend, consider that life and career is a journey, and that in this country we have the choice to ponder or pursue any, and all of the above options, and more. We have the ability to think, cogitate and ruminate, as we have done here today. So – please – thank those who have helped turn this idealistic philosophy, into pragmatic daily reality.

For us personally, we thank Bonze Star Medal Winner Captain Cecelia T. Perez, RN. Now – ponder and consider – who do you thank? If no one has impacted you up-close on this Memorial Day weekend and national holiday, please visit our military channel to reflect, comment and opine.

Link: https://healthcarefinancials.wordpress.com/category/military-medicine

Conclusion

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US Navy Ship Comfort Heads to Haiti

More on the Hatian Military Sealift Command Operations

By Dr. David Edward Marcinko; MBA

[Publisher-in-Chief]

According to www.USNavySeals.org, the Military Sealift Command hospital ship Comfort just sailed from its pier home-port in Baltimore Maryland and is now on its way to Haiti to assist in relief operations.

On board are 550 doctors, nurses, technicians and support staff who, according to the Bureau of Medicine and Surgery of the United States Navy, will give a variety of medical services, among them primary care, trauma care, pediatric care and orthopedic care. 

Assessment

I was privileged to visit the big ship last summer [2009] while on speaking tour. It is a sight to behold:

 For more info, I encourage all ME-P readers and subscribers to lean more about her:

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What’s So Special About War Doctors?

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A Special ME-P Christmas Holiday Tribute

By Dr. David Edward Marcinko; MBA

[Publisher-in-Chief]

Back in the day, I did some trauma training at Martin Army Hospital in Columbus, GA. This 250-bed facility is the center for medical services at Fort Benning. Opened in 1958, it is one of the largest and most comprehensive community hospitals in the Army. The hospital is recognized as one of the best in the nation for quality of care as certified by the Joint Commission on Accreditation of Healthcare Organizations, and service to the community by the Army and TRADOC Communities of Excellence Evaluations.

MEDDAC

Fort Benning’s MEDDAC, a major subordinate command of the U.S. Army Medical Command, furnishes medical care to an eligible patient population in excess of 72,000 beneficiaries. Since the establishment of Fort Benning in 1918, medical services have always been available. In the early days, medical care was dispensed from tents, temporary wooden buildings, and leased space in the Columbus Hospital. In 1924, services were moved into what is now the National Infantry Museum, and in 1958 Martin Army Community Hospital was opened.

Martin Army Hospital 

Martin Army Community Hospital is named in honor of the late Major General Joseph I. Martin, Medical Corps. The hospital was opened in 1958 at a cost of slightly over $6 million. As the demand for outpatient health care grew, a 59,000 square foot ambulatory care wing was added in 1975 at a cost of $3.8 million.

To support the purchase of modern medical equipment and to ensure the compliance with the JCAHO standards, an extensive electromechanical upgrade project was completed in 1980. This was my era. The latest major construction occurred in 1990 when the Emergency Room underwent renovation at a cost of $835,000. The ER now contains the latest technology available to preserve life, and can provide these services more efficiently than in the past.

Professional Training Programs

In addition to its medical mission, the MEDDAC has an extensive professional teaching and training mission, and in 1972 established the Army’s first Family Practice Residency Program. This 3-year program maintains approximately 30 residents who provide medical services throughout the hospital.

Other specialty training programs include the clinical portion of the Army’s Physician Assistant Program, a residency in Health Care Administration, Podiatric Surgery internship, training in several enlisted specialties, and numerous clinical rotations or externships conducted in cooperation with local colleges and universities. Located near the Infantry Museum is the Army Substance Abuse Program, Exceptional Family Member Program, and the Early Intervention Program. In addition to these facilities, the MEDDAC operates four Family Practice Clinics, five on-post Troop Medical Clinics (TMCs), a Reception Station, and two satellite TMCs in support of Ranger School training in Georgia and Florida.

A New York Times Re-Post

As so, it is with some degree of pride that we reprint this story from the NYTs.

###

DOCTOR AND PATIENT

By Paulinwe W. Chen; MD

One morning as a medical student on the surgery service, I learned about a patient who had been hemorrhaging on the operating table the night before. The intern who had assisted during the operation took great pains to describe every detail of the failed efforts of several senior surgeons and the final, ultimately lifesaving, maneuvers of the department chairman. “He came in and just got control of the bleeding,” the intern concluded, waving his hands as if the chairman’s work had involved magic.

Assessment

“How did he manage that?” one of my classmates asked. “He’s one of the best,” the intern answered matter-of-factly. “He was a surgeon in Vietnam.” 

More Lesson from the War Zone: http://www.nytimes.com/2009/12/11/health/11chen.html?ref=health

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Grading the Public Options That Already Exist

Understanding Existing Healthcare Plans

By Sabrina Shankman, www.ProPublica.org

October 28, 2009 12:27 pm EDT

2007 Healthcare Costs

What might a public health option look like in practice? One way to find out is to look at what’s already out there.

Link: http://www.propublica.org/ion/health-care-reform/item/grading-the-public-options-that-already-exist-1028

Assessment

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The VistA Client Server System

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What it is – How it works

By ME-P Staff ReportersME-P Rack Servers

According to Dr. Richard Mata MS, a client-server system configuration occurs when one or more “repository” computers [ known as “servers”] store large amounts of data but perform limited processing. Communicating with the server(s) are client workstations that perform much of the data processing and often have graphical user interfaces (GUIs) for ease of use.

High Functionality

Both customizability and resource use is high, depending on the desired sophistication. Many clinical medical information systems that process data directly related to patient care use this configuration.

VA Example

For instance, the Veterans Health Administration, which has implemented what is likely the largest integrated healthcare information system in the United States, uses client-server architecture. Known as the Veterans Health Information Systems and Technology Architecture (VistA), this system provides technology infrastructure to about 1,300 care facilities, including hospitals and medical centers, outpatient facilities, and long-term care centers. VistA utilizes a client-server architecture that links together workstations and personal computers using software that is accessed via a graphical user interface.

Assessment

Overall, for hospitals that have the financial and manpower resources for a significant investment in IT, client-server architectures are the fastest-growing and typically the most preferred of the system architectures, due in large part to their local adaptability and flexibility to meet changing hospital and medical center needs.

Conclusion

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The Largest Purchaser of Domestic Healthcare?

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It’s the Government – Silly

By Ann Miller; RN, MHA

[Executive Director]ERT Prison Healthcare

By far, our federal government is the largest purchaser of healthcare services, according to Robert James Cimasi MHA, AVA, CMP™ of Health Capital Consultants, in St. Louis, MO; and many others.

Obama Care

Although the government faces immense pressure to control healthcare costs, especially during the current HR 3200-3400 debates, it also faces pressure to expend additional funds in order to achieve its ostensible primary mission in its involvement in healthcare, i.e., to expand and improve public health.

Federal Payment Schemes

In many ways the government has led the way for cost control through its development of resource-based reimbursement, prospective payment systems, budget limitations and other payment schemes. However, its conflicting goals have led it to approach these controls in a hesitant and piecemeal manner rather than effecting bold, comprehensive reforms.

Consider, for example, the lack of government intervention in the face of mounting pressure to remove some of the barriers preventing a reduction in US pharmaceutical costs.

Assessment

Today, most experts agree that Uncle Sam pays for at least 51% of domestic healthcare when Medicare, Medicaid, SHIPS, the VA, Indian and Prison Healthcare Systems are considered. In fact, according to our Publisher-in-Chief, Dr. David Edward Marcinko; MBA:

‘We already have a single payer health system in this country, but most folks just don’t realize it.”

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How Proprietary HIT Vendors May Demolish Health Reform

Top Five Issues from the Longman Report

By Staff ReportersNetwork

Here are the top five quotes from the Longman Report. The author, Phillip Longman, is a senior fellow at the New America Foundation and the author of: “Best Care Anywhere: Why VA Health Care Is Better than Yours as well as The Next Progressive Era: A Blueprint for Broad Prosperity.

http://www.newamerica.net/people/phillip_longman

The List 

1. Twenty years after the digital revolution, only an astonishing 1.5 percent of hospitals have integrated information technology systems. Almost all experts agree that in order to begin to deal with the problems of the health care system, this has to change. 

2. Done right, digitized health care could help save the nation from insolvency while improving and extending millions of lives at the same time. Done wrong, it could reconfirm Americans’ deepest suspicions of government and set back the cause of health care reform for yet another generation. 

3. Thanks to the stimulus bill, $20 billion is about to be poured into buggy, expensive, proprietary software that will not bring the benefits the Obama administration hopes for. Rather, it will amount to a giant bailout of a health IT industry whose business model has never really worked. 

4. The VA’s open-source software allowed a nurse in Topeka, Kansas, to adapt for her own work a bar-code scanner she saw used at a rental-car agency. Her innovation cut the number of medication-dispensing errors in half at some facilities, and saved thousands of lives. 

5. While a few large institutions have managed to make meaningful use of proprietary health IT, these systems have just as often been expensive failures. In 2003, Cedars-Sinai Medical Center in Los Angeles tore out a “state-of-the-art” $34 million proprietary system after doctors rebelled and refused to use it.

Assessment 

http://www.newamerica.net/publications/articles/2004/the_best_care_anywhere 

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Henry Louis Gehrig, eMRs and Healthcare Reform

What’s the “Iron Horse” Got to Do with Health IT?

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]Jacobetti VA

According to UPI reports from Charlestown, WVa on August 24 2009, at least 1,200 veterans across the country were mistakenly told by the Veterans Administration [VA] that they suffered from a fatal neurological disorder.

Link: http://www.msnbc.msn.com/id/32541579/ns/health-health_care/

Panicked Veterans

One of the leaders of a Gulf War veterans group is reported to have said that panicked veterans from the states of Alabama, Florida, Kansas, North Carolina, West Virginia and Wyoming contacted the group about the error. Denise Nichols, the vice president of the National Gulf War Resource Center, reportedly blamed a “coding error” for the mistake. In medicine, we call this a “false positive.”

About Henry Louis “Lou” Gehrig

Henry Louis “Lou” Gehrig (June 19, 1903 – June 2, 1941), born Ludwig Heinrich Gehrig, was an American baseball player in the 1920s and 1930s; chiefly remembered for his prowess as a hitter, the longevity of his consecutive games played record and the pathos of his tearful farewell from baseball at age 36, when he was stricken with a fatal disease. Of course, Gehrig was known as the “The Iron Horse” for his durability. Yet, the irony is that Amyotrophic Lateral Sclerosis [ALS], or Lou Gehrig’s disease [sometimes also called Maladie de Charcot] is progressive and fatal. Lou died in 1941 after developing the illness. Will the same death-spiral happen to eHRs and Obama care?

Link: http://www.lougehrig.com

Assessment

Having rotated through the VA system as a young medical student back-in-the-day, I have never been a fan. It smacked of socialized medicine and government plutocracy, and was never a leading-edge example of domestic healthcare, in my informed opinion. Recent HIPAA administrative, security, IT and clinical medical errors are well known. So, to blame the mix-up on an insurance billing and “coding error” seems somewhat disingenuous. Especially now, at a time when eMRs and the Obama Administration’s healthcare reform itself is being vigorously debated by the citizenry. I mean, are there no human checks and balances? Would there be any human intervention if a public healthcare policy was adopted?

Of course, we have written about military medicine previously on this Medical Executive-Post, and devoted an entire channel to it. And, I do realize that more than fifty percent of us receive similar governmental care in some form, or another [Medicare, Medicaid, CHIPS, the Indian and Prison Healthcare Systems, etc].

Link: https://healthcarefinancials.wordpress.com/category/military-medicine/

Nevertheless, shall we give a new moniker to this mistake? How about “Lou Gehrig’s coding error”, and document it in our www.HealthDictionarySeries.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Is it even fair to relate this “isolated incident” to the current healthcare reform debate, the eMR conundrum and/or similar discussions on health Information Technology [IT]? Tell us what you think. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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Off-Road Touring with Dr. Marcinko [Part V]

About the Ship USNS COMFORT
By Dr. David Edward Marcinko; MBA, CMP™
[Publisher-in-Chief]
Dateline: August 4, 2009USNS Comfort Canton, Maryland

The official Navy ship USNS COMFORT [“Medical Treatment Facility”] has the primary mission to provide a mobile, flexible and rapidly responsive capability for acute medical and surgical care in support of amphibious task forces. These forces include the Marine Corps, Army and Air Force elements, forward deployed Navy elements of the fleet, and activities located in areas where hostilities may be imminent. Operations are governed by the principles of the “Geneva Convention for the Amelioration of the Wounded, Sick, and Shipwrecked Members of the Armed Forces at Sea”, as of August 12, 1949.

Mission

As a secondary mission of the ship COMFORT is providing a full hospital service asset for use by other government agencies involved in the support of relief and humanitarian operations worldwide. These mission statements are accountable to both the Reduced Operating Status (ROS) and Full Operating Status (FOS) military personnel staffed at National Naval Medical Center, Bethesda Maryland until the ship is activated. However, the ROS personnel’s immediate and number one priority is to fully activate the ship to a FOS Echelon III Medical Treatment Facility within a prescribed 5-day time frame.

Functions

In meeting these missions, the ROS personnel perform the following functions:

  • Serve as the nucleus of the critical core required to execute activations;
  • Develop, test, and maintain systems and procedures to support activation process;
  • Orient and train FOS augmenting staff;
  • Monitor/assess the medical treatment facility’s overall ability to fully activate/perform mission.

Leaders

The ship is commanded by CAPT James J. Ware DDS, with Executive Officer Captain Larnerd, and Master Chief Lohner. The home base is Baltimore, Maryland.  Upon arrival at the dock, the ME-P and I planned to meet onboard with Master David Lieberman. But, an interview was cancelled due to a last minute scheduling conflict. However, we were placed in the competent hands of our civilian tour guide, Shaun B. of Virginia. He noted 70 civilian and 700 military personnel.US Comfort

Assessment

Shaun B, informed me that despite advanced age, my application for a four month tour would be gladly reviewed. And, it is under serious future consideration as my nurse sister is a recent Bronze Star Award winner from a Combat Army Surgical Hospital [CASH] unit stationed in Iraq. I also did my trauma surgery training in Martin Army Hospital, at Fort Benning Georgia, back-in-the-day.

About Off Road with Dr. Marcinko

These sporadic off-road segments will continue through-out my 2009 summer promotional tour. Attendance at several formal and informal engagements increased since the early summer. The previously noted sales spike for our texts, handbooks and dictionaries www.HealthDictionarySeries.com continued and interest in our online www.CertifiedMedicalPlanner.com program and premier quarterly guide: Healthcare Organizations [Journal of Financial Management Strategies] www.HealthcareFinancials.com remained high.

Part IV: https://healthcarefinancials.wordpress.com/2009/08/13/off-road-touring-with-dr-marcinko-part-iv/

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Healthcare Organizations

Feds Propose Educational Website on ePHRs

Site Aimed at Consumers

[By Staff Reporters]

Conference RoomAs reported by Mary Mosquera on May 22 2009, the Office of the National Coordinator for Health Information Technology (ONCHIT) just proposed developing a Web site for consumers. The site is to contain facts about electronic-personal health record systems and their privacy policies. It aims to help consumers and patients make informed decisions.

http://govhealthit.com/articles/2009/05/22/feds-propose-phr-website.aspx?s=GHIT_260509

Assessment

The Department of Health and Human Services [DHHS] Agency information collection request, for a 30-days public comment period, is also located here.

http://edocket.access.gpo.gov/2009/E9-12023.htm

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On the Patient Friendly Google Health Initiative

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Data Integrity and Health 2.0 Accuracy Concerns Linger

google3

[By Staff Reporters]

According to its’ website, and mission statement, Google Health aims to put patients in charge of their digital health information. It’s safe, secure, and free.

Triple Play of Benefits

Google Health purports to:

  • Organize health information all in one place.
  • Gather medical records from doctors, hospitals, and pharmacies.
  • Share information securely with family members doctors and caregivers, etc.

Google says members are always in control of how data is used. It will not sell information. Members decide what to share, and what to keep private.

Link: privacy policy

Blogsite

Google health was launched in the spring of 2008. Since then, it even maintains its own blog-site, which stated on 3/4/09.

 “We continue to learn a tremendous amount since launching Google Health in the spring of 2008. We’re listening to feedback from users every day about their needs, and one issue we hear regularly is that people want help coordinating their care and the care of loved ones. They want the ability to share their medical records and personal health information with trusted family members, friends, and doctors in their care network”

Link: http://googleblog.blogspot.com/2009/03/google-health-helping-you-better.html

Good thing too!

A Cautionary Tale

However, privacy advocates worry about the vast amount of data that Google is redacting. Growing consumer market clout means the early-adopter patient who cares about digital records, and eHRs, may have fewer choices in the future. And, for medical professionals, what does this say about CCHIT, Allscripts and the Military, etc; or, the emerging Wal-Mart eMR initiative for doctors?

Assessment

For example, when one now [in]famous patient named Dave deBronkart – a tech-savvy kidney cancer survivor – tried to transfer his medical records from Beth Israel Deaconess Medical Center to Google Health, he was stunned at what he found.

Read this Link: http://www.boston.com/news/nation/washington/articles/2009/04/13/electronic_health_records_raise_doubt

Is MSN’s Health Vault any better?

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Military Electronic Dental Records [eDRs]

US Defense Department Leads the Way

By Staff Reporters

MilitaryAccording to Peter Bauxbaum on May 13, 2009, the Defense Health Information Management System [DHIMS] is in the process of deploying AHLTA [Armed Forces Health Longitudinal Technology Application] Dental; a module eDR included with the new AHLTA 3.3 release.

It is the U.S. military’s first integrated dental and medical electronic health record.

Link: http://govhealthit.com/articles/2009/05/13/dod-electronic-dental-record.aspx?s=GHIT_190509

Assessment

And so, when will eHRs for osteopaths [eOsteoRs], podiatrists [ePodRs] and optometrists [eOptRs] become available? Is this an occasion when the military is an early HIT adopter?

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Military Health System Records

Expanding PHR Pilot Testing

By Staff Reporterscomputer-hardware2

According to Paul McCloskey, on April 08, 2009, the Military Health System [MHS] will extend its test of personal health records at Madigan Army Medical Center in Tacoma, Wash., to two additional health care venues in an attempt to test the technology in larger populations and more diverse care settings.

MiCare PHR Focus

The new projects will focus on using the MiCare Personal Health Record [PHR] as a tool for care coordination and a mechanism for patients to share health records across a mix of military and commercial providers and payer organizations, according to Col. Keith Salzman, chief of informatics at Madigan, which is hosting a pilot test of MHS’ MiCare PHR.

Assessment

Link: http://govhealthit.com/articles/2009/04/08/phr-pilot-testing.aspx?s=GHIT_140409

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Reflections on a Tent Hospital

Thoughts on Pop-Up Healthcare Facilities

By Dr. David Edward Marcinko; FACFAS, MBA, CMP™

Publisher-in-Chiefdr-david-marcinko13

According to the Philadelphia Inquirer, February 10, 2009, it took Mark Ross about 22 minutes to inflate the hospital for the first time. Yesterday, he did it in 14 minutes. In the event of a large-scale emergency – a direct hit by a hurricane for example, or a plane in the Delaware River [Think Hudson River, NY]  – Ross and other volunteers can have the mobile hospital running anywhere in Southeastern Pennsylvania within two to four hours of the first alert.

The Valley Forge Experiment

The day before, on February 9, in Valley Forge PA, dozens of current and potential volunteers got to see three tan and white tents – and reams of equipment – for the first time. The $1 million cost was paid by state and federal governments. With a portable generator, 50 cots, 130 ventilators, 26 wireless cardiac monitors and 27 patient carts loaded with tongue depressors, eye shields and IV sets, the rapid-response team is intended to fill the 72- hour gap before federal emergency help arrives after a disaster.

Back-in-the-Day

Now, despite this Valley Forge innovation, mobile, semi-permanent and pop-up healthcare facilities are not a new machination in civilian life or non-warfare times. In fact, please allow me to tell you of my canvass tent-hospital experience, back in the late seventies.

My Tent Hospital

At the time, I was completing my training program as a senior attending resident [SAR], and surgical fellow. The “hospital” where I moonlighted was located in a sleepy town about 40 miles North of Atlanta, Ga. Driving there in my lime-green, oil-burning 1969 Chevrolet Impala with balding tires [retreads] was always novel experience.

As I recall history, the tent-hospital began as a private medical clinic in a three bedroom converted brick ranch-house that was the style in the late 1950s’-60s. It was the private practice of a solo practitioner-internist for his rural patients who lived on farms too far from the big city – or for patient’s who mistrusted the medical establishment. There were many. It grew quickly, from the days before Medicare/Medicaid reimbursements, to modernity.

Think Cirque du Soleil

Expanding to a larger facility, with sparse economic resources, necessitated innovative thinking at the time. The hospital itself was a very large circular tent [bulls-eye configuration], built on semi-permanent concrete foundation with trampoline-like floor. The tent was shaped like a disc or sphere. In the center was an operating room for the visiting general surgeon. The next concentric layer was comprised of four rooms. The admissions, records department and triage room; a dirty-room with toilet; a clean room with bed and shower; and a kitchen with doctor/nurse station and lounge. The next third outer concentric layer consisted of about twelve patient “rooms”. The patients entered each room from the inner second layer, while the doctors and nurses opened a door-slot on the outer third layer for the introduction of food, information, gowns and equipment, visitor chit-chat and medications, etc. Each room was muck like a dungeon, jail or cell [Recall the Seinfeld episode where Kramer housed visiting Asians in his cabinet drawer or shelf]. The docs and nurses continually circulated the third outer “floor” layer, ministering to their respective patients. By the way; no staff nurse ever complained of tired feet, leg soreness or calf cramps because of the springy trampoline-like floor.

Not a TV MASH Unit

tent-man

This “hospital” was not like a military MASH unit, at all. It was definitely civilian in nature, purpose and construct:

Think: Army CASH unit; not MASH unit.

CASH = Combat Army Surgical Hospital [semi-permanent].

MASH = Mobile Army Surgical Hospital [ambulatory]  

My Experiences

During my summer working there, I managed a small part-time, two-room medical clinic with a singular nurse. We treated all sort of minor injuries and ills, cuts, scrapes; boils and blisters; aches and sprains; dog bites, bee stings and allergies, and simple closed extremity fractures, infections, etc. I even operated on a half-dozen patients under local anesthesia with conscious sedation. For the holidays, I received presents from several nurses and patients who remembered me from the previous summer.

New Facility

My “tent hospital” was in operation for almost two decades before the founding physician retired. The site was replaced by a publically funded, much larger and permanent “modern” facility, as the surrounding suburbs grew. The new Woodstock Hospital is now a short-term facility, with 21 beds, but is not yet rated by any hospital service agency because of statistically low volume requirements. It is a District Authority owned hospital facility.

Source: Centers for Medicare and Medicaid Services for the years 2005-2007. 

Assessment

Now, here’s the thing. My tent-hospitals’ claim-to-fame was that it, at the time of closure, was the only hospital in the State of Georgia to have never had a hospital acquired [nosocomial] or post-operative infection? To my knowledge, the feat has not been duplicated in this state. Of course, the new facility was not so fortunate. Increased medical acuity, treatment services and a different-mobile patient population was cited as the likely culprit.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Quality initiatives are good. And, health 2.0 information technology is the future of medicine. But, sometimes, prologue is past.

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BCBS-TX Dental Insurance is Rude to Everyone

Why the Long NPI – BCBSTX?

[By Darrell Pruitt; DDS]pruitt5

More than a year ago, Dr. Robert Ahlstrom, an ADA [American Dental Association] and NHII (National Healthcare Information Infrastructure) task force member, told attendees to the ADA’s 3rd International Evidence-Based Dentistry Conference that the NPI number is

“Critical to the future of dentistry.” 

But, to this day, he refuses to reveal why. Even though I have learned that he is a very shy man on the Internet; on that Sunday in May in ADA Headquarters, he confidently added,

“It is only voluntary unless you want to get paid.” 

His case-closed proclamation shut down discussion cold in a Soviet manner. Did I mention that this occurred at an “Evidence-Based Dentistry” conference? Soviet East Germany was also called the German Democratic Republic.

NPI Harmful to Dentists and Patients

There is nothing evidence-based or otherwise about the NPI number – that benefits anyone but healthcare stakeholders. In fact, the number actually harms both dentists and patients. Like Ahlstrom, the irreversible NPI number is simply un-American. However, the NPI means profit for sleazy dental insurance companies like BCBS of Texas – especially when dentists’ reimbursements for work done long ago are delayed by NPI-NPPES screw-ups.  Some physicians’ payments have been delayed for a year or more because of NPPES crosswalk difficulties. Who needs that?

Veteran’s Example Scenario

A new patient called my office this week wanting an appointment to start a crown. We don’t normally block off two and one-half hours for a patient on the first visit, but the Veteran told my office manager that before he was recently discharged, they did a root canal, post build-up and temporary on a tooth that still needs a crown. I like to think other dentists would also risk big holes in their schedules for Veterans. We owe them at least that much.

BCBSTX Dental Insurance

When he showed up with his BCBSTX dental insurance information, my office manager had to tell him that even though his boss was promised by the BCBSTX sales representative that the dental benefits package he bought for his employees was good anywhere, it cannot be used in my office because I do not have an NPI number. I am licensed to practice dentistry in the state of Texas, but that is not enough for BCBSTX. Capricious qualifications are certainly their choice if they prefer to do business that way in Texas, but why does BCBSTX leave it to my office manager to inform their clients about their deception?  If a client who pays premiums to BCBSTX likes a dentist who does not have an NPI number, those premiums are pure profit for BCBSTX. It is easy to understand that the more obstacles BCBSTX can put between their clients and obligations to cover their dental bills, the bigger are the bonuses for executives. What’s more, BCBSTX’s leaders’ lousy work ethic permeates the entire dental insurance industry. Compared to BCBSTX executives, AIG executives who kept bonus money should be honored as national heroes. 

BCBSTX Rude to Everyone 

As the Veteran who almost became my patient works to fit him-self back into society, perhaps the next opportunity he has to break away from work for a few hours, he will be lucky enough to come across a dentist who has an NPI number. If things go well, BCBSTX will not have wasted a Veteran’s time twice – and wrecked a dentist’s schedule – for what? BCBSTX has nothing against Veterans in particular, they are rude to everyone.  Since nobody from the company can be held personally accountable, tyranny is as natural as Ponzi schemes.

Attention Texas Employers: 

I wish deceptive business practices which insurance companies use to cheat their clients were against the law in Texas. Attention Texas employers; as a dentist who has witnessed harm from BCBSTX, I warn you not to waste money on their dental plan. BCBSTX’s sales reps cannot be trusted to tell the truth and will aggravate your employees as well as neighborhood dentists. 

Assessment

If BCBSTX gets away with this dishonesty, what other senseless, but profit-enhancing hoops will they demand next year?  How many more dentists and patients can an Attorney General allow them to cheat before speaking up? Come out and fight for your honor, BCBSTX … or not.  I bring more than your best attorney can handle and I am waiting.

Conclusion

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Illuminating the Congressional Federal Health Board

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A Next-Gen -or- Last-Gen National Model  

[By Dr. David Edward Marcinko; MBA, CMP™]

[By Staff Reporters]

 

 

 

 

 

 

Beware; all Medicare and other private health insurance recipients.

Why?

On December 4, 2008, and according to Robert E. Moffit PhD, the Director of the Center for Health Policy Studies [CHPS] at The Heritage Foundation, Presidential Obama proposed the creation of an institute that would judge the “comparative effectiveness” of medical treatments, procedures, and therapies, as well as drugs, devices, and technologies.

Congressional FRB Model

This Congressional Federal Health Board [FHB] would be modeled on the Federal Reserve Board [FRB] with a governing body of politically appointed experts, but “insulated from politics” and  possess many powers similar to the proposed National Health Board [NHB], a key feature of the ill-fated Health Security Act [HSA] of 1993.

New Health Board

This new health board would also:

  • Set the rules for health insurers who would participate in a national health insurance exchange and recommend benefits coverage, including drugs and medical procedures backed by “solid evidence”;
  • “Rank” therapies and medical services based on their cost effectiveness;
  • Suggest priorities for medical research; and
  • “Align incentives with the provision of quality care,” as defined by the health board, through Medicare-style “pay for performance” rules for doctors and other medical professionals who comply with government practice guidelines.

Assessment

For ordinary Americans unsatisfied with the new Federal Health Board, there would be little recourse since it would likely be independent of Congress and the White House. For medical providers, according to Hope Hetico; RN, MHA of this Medical Executive-Post, it would be an operational nightmare that makes the managed care logistical problems of condition coverage, pre-certifications and pre-treatment authorizations, etc., seem a non-issue.

In other words, is this new FHB really the next-generation of medical collaboration and communication vis-a-vie health 2.0; or just another bloated last-generation command control model?   

Link: http://www.heritage.org/research/healthcare/wm2155.cfm

Conclusion

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Tragedy at William Beaumont Army Medical Center

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Thousands at Risk from Needle Contamination

[By Staff Reporters]

56372274

According to Derek Shore of Veterans Today, on February 7, 2009, the Army Medical Center announced that 2,114 diabetic patients treated at the hospital may be at risk for contracting blood-borne illnesses.

Improper Insulin Injections

Hospital administrators reported to local station, KFOX, that diabetic patients at the hospital were being injected with insulin improperly. A medical injection pen was being used on more than one patient. Even though the needle was changed with each patient, there are fears the insulin reservoir may have contained diseases from past patients, which has sparked the fear of contamination.

Assessment

Doctors said the patients could be at risk of being given blood-borne diseases from August 2007 until Friday, February 6, 2009.

William Beaumont Army Medical Center has set up a toll-free hotline at 1-866-770-0194.

Link: http://www.veteranstoday.com/modules.php?name=News&file=article&sid=4726

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Conclusion

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eMR Military Speech Recognition Technology

HIT in Military Medicine

By Staff Reporters

Did you know that physicians are using speech recognition tools to enhance patient electronic Medical Records [eMR] in the military?

Assessment

It’s true! According to Information Week, and by 2011, the Defense Department expects its integrated, interoperable electronic medical records system to be in place at 500+ military medical facilities worldwide.

More info link: www.informationweek.com/1188/ehealth.htm

Conclusion

Your thoughts are appreciated?

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More on Captain Cecelia T. Perez RN

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Army Bronze Star Medal Interview

[By ME-P Staff Writers]ME-P Logo.2

Recently, Medical Executive-Post writers caught up with Captain Cecelia T. Perez for more information on the exact circumstances surrounding her Bronze Star Medal Award.

Interview Synopsis

Self-effacing and humble, Cecelia simply stated in her email interview that the medal was “basically for saving lives” while in Iraq. 

Only when pressed for more details, did Cecelia explain – “My friend Bill and I set up trauma sites separate from the rest of our company. First, in Talafar, Iraq for five months and then at COP Gabe in Baquoba, Iraq during our brigade’s retaking of that city.” 

She noted that “we had some serious trauma to deal with as we responded to Iraqi Army mass casualty events at their aide station which was also located near us.” 

Unfortunately, “they did not have a PA or doctor like we did, so Bill and I, along with our medics, responded to their requests for help.”

Of course, Cecelia mentioned several times that it was a medical team group effort.

But, “they obviously appreciated our efforts as gender, racial, and cultural barriers disappear in the midst of the bleeding and the wounded.”  

Assessment

We say: A real American Army Hero would have it no other way!

Conclusion

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The Bonze Star Medal Confirmed

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Bonze Star Medal for Captain Cecelia T. Perez; RN

Breaking News Washington, DC

***  

THE UNITED STATES OF AMERICA 

TO ALL WHO SHALL SEE THESE PRESENTS, GREETING: THIS IS TO CERTIFY THAT THE PRESIDENT OF THE UNITED STATES OF AMERICA AUTHORIZED BY EXECUTIVE ORDER, 24 AUGUST 1962 HAS AWARDED 

THE BRONZE STAR MEDAL  

To: CAPTAIN CECELIA T. PEREZ

CHARLIE COMPANY, 296th BSB, 3rd BRIGADE, 2nd INFANTRY DIVISION 

For: Exceptionally meritorious service while assigned as the Brigade nurse during Operation Iraqi Freedom. Captain Perez’ exceptional dedication to mission accomplishment, tactile competence and unparalleled professionalism contributed immeasurably to the Unit’s success during combat operations. Her actions reflected distinct credit on her, the multinational Division-Baghdad, and the United State Army.  

– 5 July 2006 to 5 October 2007 –

GIVEN UNDER MY HAND IN THE CITY OF WASHINGTON, DC

Joseph F. File, Jr. Major General, USA

Commanding: PO #259-100

16 September 2007

Conclusion

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US Army Captain Perez and the Bronze Star Medal

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Un-Confirmed “Breaking News” Report

By ME-P Staff Writers [Baltimore, MD]

The Medical Executive Post has received an anonymous and unconfirmed report that Captain Cecelia T. Perez of Baltimore, Maryland, will be awarded the Bronze Star Medal from the United States Army. 

About the Bronze Star [Wikipedia] 

The Bronze Star Medal is a US Armed Forces individual military decoration which may be awarded for bravery, acts of merit or meritorious service. When awarded for bravery, it is the fourth-highest combat award of the U.S. Armed Forces and the 9th highest military award (including combat and non-combat awards) in the order of precedence of U.S. military decorations. The medal may be awarded for Valor (i.e. a particular instance of combat heroism), in which case it is accompanied with an attached “V”, or it may be awarded for Meritorious Achievement (i.e. doing one’s combat job well over a period of time) in which case the medal does not have a valor component and does not have an attached V denoting Valor. Most of the bronze stars awarded are meritorious and do not have the V device. The medal is awarded to a member of the military who, while serving in or with the military of the United States after 6 December1941, distinguished him-or herself by heroic or meritorious achievement or service, not involving participation in aerial flight, while engaged in an action against an enemy of the United States; while engaged in military operations involving conflict with an opposing foreign force; or while serving with friendly foreign forces engaged in an armed conflict against an opposing armed force in which the United States is not a belligerent party. 

Awards may be made for acts of heroism, performed under circumstances described above, which are of lesser degree than required for the award of the Silver Star. Awards may also be made to recognize single acts of merit or meritorious service. The required achievement or service, while of lesser degree than that required for the award of the Legion of Merit, must nevertheless have been meritorious and accomplished with distinction. 

To be eligible for the Bronze Star Medal, a military member must be receiving hostile fire/imminent danger pay during the event for which the medal is to be awarded. As of 30 October2000, the Bronze Star Medal may not be awarded to Department of the Army civilians. 

History 

The Bronze Star Medal is typically referred to by its full name (including the word “Medal”) to differentiate the decoration from bronze service stars which are worn on campaign medals and service awards. The award that eventually became the Bronze Star Medal was conceived by Colonel Russell P. “Red” Reeder in 1943, who believed it would aid morale if there was a medal which could be awarded by captains of companies or batteries to deserving people serving under them. Reeder felt the medal should be a ground equivalent of the Air Medal, and proposed that the new award be called the “Ground Medal”.

The next metal awarded was to Cerinetti, Frank R. from the Battle of the Bulge. He was awarded the metal because of his braveness and victory over the Germans. With this he is known as one of the heroes of WW2. Since the award criteria state that the Bronze Star Medal may be awarded to “any person…while serving in any capacity in or with” the U.S. Armed Forces, awards to members of foreign armed services serving with the United States are permitted. Thus, a number of Allied soldiers received the Bronze Star Medal in World War II, as well as U.N. soldiers in the Korean War, Vietnamese and allied forces in the Vietnam War, and coalition forces in recent military operations such as the Gulf War, Operation Enduring Freedom and the Iraq War.

Appearance 

The Bronze Star Medal was designed by Rudolf Freund (18781960) of Bailey, Banks and Biddle. (Freund also designed the Silver Star.[1]) The Bronze Star is a bronze star 1½ inches (38 mm) in circumscribing diameter. In the center thereof is a 3/16 inch (4.8 mm) diameter superimposed bronze star, the center line of all rays of both stars coinciding. The reverse has the inscription “HEROIC OR MERITORIOUS ACHIEVEMENT” and a space for the name of the recipient to be engraved. The star is suspended from the ribbon by a rectangular shaped metal loop with the corners rounded. The ribbon is 1 3/8 inches (35 mm) wide and consists of the following stripes: 1/32 inch (1 mm) white 67101; 9/16 inch (14 mm) scarlet 67111; 1/32 inch (1 mm) white; center stripe 1/8 inch (3 mm) ultramarine blue 67118; 1/32 inch (1 mm) white; 9/16 inch (14 mm) scarlet; and 1/32 inch (1 mm) white.

Devices 

Additional awards of the Bronze Star Medal are denoted in the Army and Air Force by oak leaf clusters. The Navy, Marines, and Coast Guard issue award stars to denote subsequent decorations. The Valor device (or “V device”) is authorized by all services and identifies the award as resulting from an act of combat heroism (as in the case of the army and air force) or signifying that the medal was earned in combat (as in the case of the navy), thus distinguishing it from meritorious achievement awards. However, an accumulation of minor acts of combat heroism does not justify an award of the Valor device. Combat service deserving a bronze star, but not achieved in a particular valorous act, would warrant a meritorious bronze star. The Valor device does not denote an additional award. Only one may be worn on any ribbon. 

Legal 

Any false verbal, written or physical claim to an award or decoration authorized for wear by authorized military members or veterans is a federal felony offense punishable by up to a year in jail and up to a $5,000 fine. 

About Cecelia Teresa Perez; RN 

Cecelia T. Perez is a Board of Directors [on military leave-of-absence] member for the 2-volume, 1,200 pages, print-journal guide Healthcare Organizations [Financial Management Strategies].

She is also an on-leave corresponding journalist for the Medical Executive Post.

Confirmation Still Needed 

This “breaking news” story is still developing. Please contact the Medical Executive Post if you can confirm or deny the report. 

Contact:MarcinkoAdvisors@msn.com  

Conclusion

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A Real American Healthcare Hero

Call to Action: VAMCS Employee Inspired to Serve 

By Staff Writers

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Captain Cecilia “Terry” Perez, Baltimore VA Medical Center emergency and operating room nurse, answered an internal call to duty after the attacks of September 11.  She told her story exclusively to the Executive Post, and Defend America – an electronic newsletter published by the U.S. Department of Defense.

 

Her story is extraordinary because she decided to join the Army at age 44.  “I felt very proud to be working with our veterans at the time of the events of September 11,” commented Terry.  “Their stories, courage and pride in serving their country in their generation’s time of crisis inspired me to investigate the possibility of joining the reserves.”  

Initially, Captain Perez ANC served with the 67th Combat Support Hospital (CSH) in Tikrit, Iraq, during Operation Iraqi Freedom II.  She makes us proud of her courage in the field and awed by her talents as the ultimate strategist. 

Terry is now stationed at Ft. Lewis in Washington State, having just returned from Baghdad and Baqouba, Iraq. She is with the 3-2 SBCT (Third Brigade, Second Infantry Division, Stryker Brigade Combat Team).

Today, at age 50, she hopes to be discharged by the summer of 2008; a full six years after her heroic journey began. She will then resume blogging, writing, editing and her position as print-guide BOD member.  

And no doubt, a book of her experiences is in the works. 

http://www.defendamerica.mil/CallAction/CalltoAction.html

 

Cecelia

Conclusion

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