Pepper sprayed for public safety.

[Gattigap]

Originally Posted by Replaced_Texan

I see Texas more than anywhere else just because that's where I am, but I got the impression that it was a national thing. The docs around here are absolutely terrified the most of the Payment Advisory Board. OTOH, everyone right and left is creating an ACO. I think they probably would have wanted to do it anyways, since they are all into consolidation.

FWIW, the guys that I work with are in the same spot. We work with providers mostly on the coasts, and business has been booming (and expect it to accelerate now).

There's also the states, and the exchanges. A number of states have delayed putting up their own exchanges either because (a) they can't get out of their own way, and/or (b) they calculated that Obama would lose and after Day One, they wouldn't have to think about it anymore. Now they do, and are under the gun to figure out if they're going to scramble to set up a state exchange themselves, or leave it to the jackbooted thugs at the federal level.

[Greedy,Greedy,Greedy]

Originally Posted by Replaced_Texan

I see Texas more than anywhere else just because that's where I am, but I got the impression that it was a national thing. The docs around here are absolutely terrified the most of the Payment Advisory Board. OTOH, everyone right and left is creating an ACO. I think they probably would have wanted to do it anyways, since they are all into consolidation.

The systems I know best have definitely been planning for implementation. One part of that has been massive capital investment right now to improve costs down the road, and that was probably a long time coming. Some of it is a big bet that technology is the winning game for the IPAB. For the stuff I do, which usually involves these systems as purchasers or as inventors, it's been great. Lead time for capital purchases has declined significantly.

[Greedy,Greedy,Greedy]

Originally Posted by ThurgreedMarshall

http://whitepeoplemourningromney.tumblr.com/

TM

Love that. Hadn't seen it in 24 hours. Awesome.

[Sidd Finch]

Originally Posted by Tyrone Slothrop

I'm not altogether unfamiliar with what the CFPB is doing from the perspective of the regulated party, and I really don't understand what all the bitching is about.

Buckyballs, I think.

[Replaced_Texan]

Originally Posted by Greedy,Greedy,Greedy

The systems I know best have definitely been planning for implementation. One part of that has been massive capital investment right now to improve costs down the road, and that was probably a long time coming. Some of it is a big bet that technology is the winning game for the IPAB. For the stuff I do, which usually involves these systems as purchasers or as inventors, it's been great. Lead time for capital purchases has declined significantly.

Yeah, I don't see how it's cost effective to run a small practice anymore. One of my cousins just allowed his otphalmology practcie get gobbled up by a larger practice (owned in part by another cousin, my dad has four first cousins that are opthalmologists), and he's overjoyed. No more worries about overhead or tech implmentation anymore. Just practice medicine and let someone else worry about the administrative stuff. We've been on a buying spree as well, mainly GP clinics that were already feeders to our specialty clinics and a few ortho clinics.

Integration, though, is really hard. Texas is a coroporate practice state. Hospitals can't own docs. Makes for all sorts of chinese walls and contortions, and makes data sharing a right pain in the ass. Especially when everyone went out and spent a lot of money on EMRs a few years ago and don't want to give theirs up for the other guy's. Even though everyone hates their EMR. The Epic people look longingly at Allscripts, and our Allscripts folk get pissed off every time they hear about someone else's functionality.

There are a few HiEs taking off. I'll be very curious to see how those pan out. Employees snooping around in the EMR is the most common breech we have (and I suspect everyone else too). Those HiEs are going to have tons and tons of data. I'm really nervous about so many people having access to them.

[Sidd Finch]

Originally Posted by sebastian_dangerfield

Note to Sidd: I'd never stoop to trying to gotcha you like that. Those sorts of exchanges are dull. And I'd hope you think enough of me to realize I understand that how people recall things, or describe past views/perceptions, change from day to day, memory being anything but perfect.

I see no inconsistency with anything you said today and anything you said in the past, have never thought there was any lack of clarity in your general views on the topic at hand, and even if there were, it would be so minor, or so attributable to human nature, there'd be no point in noting it. Unless, of course, I wanted to bore people, or gift myself a pointless, self-congratulatory "gotcha."

Well lah-di-dah, aren't we all mature today.

[Hank Chinaski]

Originally Posted by Replaced_Texan

Yeah, I don't see how it's cost effective to run a small practice anymore. One of my cousins just allowed his otphalmology practcie get gobbled up by a larger practice (owned in part by another cousin, my dad has four first cousins that are opthalmologists), and he's overjoyed. No more worries about overhead or tech implmentation anymore. Just practice medicine and let someone else worry about the administrative stuff. We've been on a buying spree as well, mainly GP clinics that were already feeders to our specialty clinics and a few ortho clinics.

I wonder if this is different from how Big Law bought up boutiques to get niche markets- my first IP firm merged into the biggest firm in the state since the Managing GPs wanted to lose all those headaches. Within 5 years pretty much everyone of us jumped to get away from the people now making the decisions re our practice and compensation and the red tape- within 10 years 90% of us were back in boutiques.

[Sidd Finch]

Originally Posted by ThurgreedMarshall

This can't be an honest question. They came up because lunatic republicans have been pushing to end Roe for decades. Each year they take another step in curtailing that right. And they've been so successful at the local levels, and feel so fucking emboldened by their idiot Tea Party candidates, that they have pushed too fucking far again and again. That, plus their idiotic religious views, which necessarily put them in a position of saying that everything God does is justifiable, means they are going to say and propose stupid, insane shit all the time.

TM

It's the same bubble, the same kowtowing to the extreme, the same pandering in the primaries, that led all the R candidates to say that they would oppose a budget deal that had a TEN-TO-ONE ratio of spending cuts to tax increases.

Re-fucking-dick-you-luss.

[Hank Chinaski]

http://www.crainsdetroit.com/article...surance-reform

isn't this story about an added cost that will be added to the those making under $250K- us corner office guys don't eat at Red Robin so it doesn't impact me-

Or is the thought that restaurants should have provided health care all along and this merely levels the playing field for chains that always did provide health care?

[Hank Chinaski]

Originally Posted by Sidd Finch

It's the same bubble, the same kowtowing to the extreme, the same pandering in the primaries, that led all the R candidates to say that they would oppose a budget deal that had a TEN-TO-ONE ratio of spending cuts to tax increases.

Re-fucking-dick-you-luss.

my point was, at that point they were arguing with themselves- I think Sebby got it right. 10 to 1 on budget was at least still arguing with Dems.

[Sidd Finch]

Originally Posted by Adder

We had a tiny bit of that in school (I recall having to balance a checkbook), but not much.

I 100% agree that basic personal finance should be a point of emphasis for education.

Yes, but it should start with "If you haven't read the document, don't sign it. If you read it and you can't understand it, don't sign it. If the guy asking you to sign it 'explains' it, have him put that explanation in writing and attach it to the document before you sign it. If he says you don't need to read it before you sign it, walk out and never talk to him again."

Problem is, we are all getting more and more used to checking "accept" without reading shit before we download software. So I might add "And borrowing several hundred thousand dollars is nothing like downloading version 3.2.1.2.3 of iTunes, so don't fucking act like it is!"

[Greedy,Greedy,Greedy]

Originally Posted by Replaced_Texan

Yeah, I don't see how it's cost effective to run a small practice anymore. One of my cousins just allowed his otphalmology practcie get gobbled up by a larger practice (owned in part by another cousin, my dad has four first cousins that are opthalmologists), and he's overjoyed. No more worries about overhead or tech implmentation anymore. Just practice medicine and let someone else worry about the administrative stuff. We've been on a buying spree as well, mainly GP clinics that were already feeders to our specialty clinics and a few ortho clinics.

Integration, though, is really hard. Texas is a coroporate practice state. Hospitals can't own docs. Makes for all sorts of chinese walls and contortions, and makes data sharing a right pain in the ass. Especially when everyone went out and spent a lot of money on EMRs a few years ago and don't want to give theirs up for the other guy's. Even though everyone hates their EMR. The Epic people look longingly at Allscripts, and our Allscripts folk get pissed off every time they hear about someone else's functionality.

There are a few HiEs taking off. I'll be very curious to see how those pan out. Employees snooping around in the EMR is the most common breech we have (and I suspect everyone else too). Those HiEs are going to have tons and tons of data. I'm really nervous about so many people having access to them.

Yeah, I'd been watching a system that agreed to go all-Epic and has now been bogged down in a 6 month discussion of what "all" means. It sure as hell doesn't mean everything.

[Greedy,Greedy,Greedy]

Originally Posted by ThurgreedMarshall

http://whitepeoplemourningromney.tumblr.com/

TM

This tumblr reallly needs a good shot of Bibi.

[Replaced_Texan]

Originally Posted by Hank Chinaski

I wonder if this is different from how Big Law bought up boutiques to get niche markets- my first IP firm merged into the biggest firm in the state since the Managing GPs wanted to lose all those headaches. Within 5 years pretty much everyone of us jumped to get away from the people now making the decisions re our practice and compensation and the red tape- within 10 years 90% of us were back in boutiques.

This happened about 15-20 years ago with managed care. Hospitals started trying to run practices, bought them right and left, set up all sorts of docs on boards and such. Then it turned out everyone hated managed care and the hospitals aren't actually any good at running docs, so they were all spun off. Some docs opened their own hospitals, but by and large, most went back to groups. Though the groups were much larger than they were prior to the managed care experiment.

This time around, though, the tech is going to be really hard to set up for a small shop. Meaningful use is in the carrot phase right now, but it's going to switch over to stick in the next few years. If docs aren't on EMRs, they're going to take a pay cut. And docs are ridiculously cheap. They hate paying for any sort of overhead.

And there are a lot of problems with EMRs. There are cut and paste problems. There are the number of clicks you have to go through to get everything done. There are major upcoding problems. Some of the old dictation, which brought forth beautiful and meaningful notes, won't be accepted for meeting the meaninful use standards. There are screens and screens to scroll through before you find what you're looking for.

It's easier for docs to let a larger system / practice own the headache of the EMR than to try to implement it themselves.

The hospital based docs will probably still be able to remain somewhat independent, so long as they're in a place that they can still get referrals and are guaranteed a spot on the medical staff.

[Replaced_Texan]

Originally Posted by Greedy,Greedy,Greedy

Yeah, I'd been watching a system that agreed to go all-Epic and has now been bogged down in a 6 month discussion of what "all" means. It sure as hell doesn't mean everything.

I sat on the Allscripts review board for a year. It was basically a monthly bitch session from docs about how much they hate Allscripts. That board changed into the Meaningful Use Implementation group, and fortuantely, they left me off the invite list.