Subject: News from Dr. Kevin Fickenscher
From: "Dr. Kevin Fickenscher" <[email-masked]>
To: <[email-masked]>
Date: Tue, 17 Apr 2012 17:23:02 -0400 (EDT)

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The Fickenscher Files [http://r20.rs6.net/tn.jsp?e=001FlfP3jzFpuM_ARb70P4IwkeTlrSllXFBcMC5OWJyCvGh2VaHURT5o0zCVirg54gsrzEt2zJv2mzAZOpSoEVvPO2f7aBHOOh3FiYh-dckjoWWWynHXd8OpCoP358dfVKqDmzP69834DA=]
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The Fickenscher Files, Vol. 2, issue 9
Kevin M. Fickenscher, MD, CPE, FACPE, FAAFP
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Quote of the Week

"The notion that Congress wrote the law in a manner that would exclude many families
from access to more affordable coverage...

is simply incongruent."

Representatives Sander Levin (D-MI) of the House Ways and Means Committee and Henry
Waxman (D-CA) of the House Energy and Commerce Committee in a letter to the Treasury
Department on the method for determining eligibility for tax credits related to 
health insurance coverage.

"Data is the new petroleum!"

An anonymous venture capitalist noting the opportunities that exist in healthcare
related to the future of the information technology space.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Consulo Indicium

Information for your Consideration ...

Care Coordination Initiatives Blooming this Spring - In an effort to design a better
system and reduce overall costs for the state's Medicaid program, Connecticut will
be submitting a waiver project to the U.S. Department of Health and Human Services
next month calling for a program that will improve care coordination by developing
and supporting "health neighborhoods." The program will use teams of healthcare 
providers who will take a more holistic approach to a person's care and will be 
focused on the 57,000+ people who represent nearly 40 percent of the total Medicaid
healthcare expenditures for the state.

Medicaid is the largest single item in the Connecticut state budget--a situation
 that is similar to many states across the country. State officials argue that despite
the price tag, the healthcare services received by the Medicaid population are often
inadequate. There are care coordination efforts springing up all over the nation
 as states and other groups grapple with how to manage care better, enhance quality
and reduce costs. Expect other states to propose ideas similar to the Connecticut
initiative.
Proposing Healthy Food for Health Organizations - An advocacy group, Corporate Accountability
International (CAI), recently sent a letter to nearly two dozen hospitals hosting
McDonald's restaurants calling on them to evict their fast-food tenants and to "stop
fostering a food environment that promotes harm, not health." In addition, CAI leads
a national campaign that is attempting to stop marketing efforts by McDonald's to
kids, an effort that has been endorsed by nearly 2,000 health professionals.

Wearable Devices Continue to Evolve - Researchers at Oregon State University and
 the University of California at San Diego have developed a "life and activity monitor"
which is a non-invasive, wearable electronic device that captures vital signs such
as heart rate and respiration while simultaneously recording a person's activity
 level. Data captured by the device is downloaded and used for augmenting the assessment
of the patient's medical condition. The device measures only two inches wide and
 can operate for a week without the need for recharging its batteries. Patrick Chiang,
Assistant Professor of Computer Engineering at Oregon State University, observed
 that, "When this technology becomes more miniaturized and so low-cost that it could
almost be disposable, it will see more widespread adoption. It's already been used
in one clinical research study on the effects of micronutrients on aging and monitoring
of this type should have an important future role in medicine."

I've been predicting for a number of years that the hospital of the future is your
living room. Non-invasive devices clearly make that concept much more of a reality.
Combined with electronic scales and portable lab analytics, common problems such
 as uncomplicated congestive heart failure will be treated BEFORE they require hospitalization.
Technology is changing the very notion of how and where healthcare is provided.

The Problem of Low Hanging Fruit In Healthcare - Last week, I attend a conference
on aging and healthcare sponsored by the Tufts University Human Nutrition Laboratory.
Virtually every lecture addressed an issue that is epidemic in the United States--OBESITY!
A new study in Health Affairs, reported that the annual cost of obesity is $344 
billion a year [http://r20.rs6.net/tn.jsp?e=001FlfP3jzFpuMKh9CjPlaY4-Wkpm-fG51OyOjQ307lxv9c1SOaiXhtZA5I_knL8YHCxLKXoF7EbnuV9-wvnd9GXWYY69mGA3G0zGexfGgaJFXulnezEzYRk0kCyRFVi2Zbf0x--JBS82DiHcKDt27wLBZfPWue_ZUDKZMTLKbyD8pBfNlgck9FlSCiwVszwc3-ERJZt3BpcBY=]
or 21 percent of total U.S. healthcare costs. Astounding. What's even more astounding
is that we all know it.  So, what are we doing about it?

I know that there is variability on the actual cost of obesity. The July 2009 issue
of Health Affairs, reported that the tab was $147 billion dollars per year [http://r20.rs6.net/tn.jsp?e=001FlfP3jzFpuMYHILTvW18U5KP4nTPi2wyC63cH3UmNh2nPaiBqUGV2BawrRXqlkHj5MGqRSC77g_R2XyR0_1XB6Q38KJ4XOKx2o9jfYJYreawsK02CrLxG1hciTYTp1trAlovFCbvnHxBn3fyCekY4g==].
In research from Cornell University in the Journal of Health Economics, obesity 
healthcare costs [http://r20.rs6.net/tn.jsp?e=001FlfP3jzFpuMCT8-0sUmTRAy5Q_I-919PPbHEgF4cXweZLxiuyL94wabucs8WmbpSTaxUM8nUiVVJu6vDqwz50RE6wU7cItjTstFUe49nXjDQVQwaXDVP3qmOWzsviuDVact2LtXJQg3oF1gCyjRXueTm6ZFKLdntHhzvURYJf0fkeHDDN2Ky_g==]
for an obese person totaled an increase in annual medical costs of $2741 [http://r20.rs6.net/tn.jsp?e=001FlfP3jzFpuOXqzsmNqu2wRHPtz4Q7_kU0ohwZusHKpy27VNKqPvo_ZhET-T_zI75bceFuSWC2EPpIrolMK0alJ7xH7Hn5LEdd70Cb1y0y1EkEx0RQWlWst1i3et9BQRzivepdo4LuUeZKuNeSj9HO54O_Y9JSfAXsUu4I46K25ztldL40sEP6VHW4rJjDF-7FNcYtJfrRBY=]
(in 2005 dollars) over the costs for a non-obese person. Pick your number. In some
respects, it doesn't make any difference. The issue is "Hey, Houston, we've got 
a problem!"

Obesity increases the risk of cancer, stroke, heart attack and diabetes to say nothing
about the complications associated with obese patients--anesthesia, healing, orthopedic
problems and the list goes on. I figure I can be outspoken on this issue since I
 once weighed 398 pounds at my zenith. I have been at a more svelte 175 +/- 2 pounds
for the last six years and all of my attending healthcare problems have disappeared.

We need to tackle the low hanging fruit problem. With one-fifth of America's healthcare
dilemma tied to one problem, it is obvious where we should focus our time and energy.
 We did it, and continue to do it, for smoking.  Now, let's take on the next 20-year
journey of tackling obesity. Society needs it. People will benefit. We can make 
a difference. Enough of the rant, but ... think about it. We need to address this
problem and everyone needs to get involved.

A Contrarian Study: ACA Will Increase Deficit by $340 Billion in the Next Decade
 - The conservative policy analyst whom President Obama appointed as one of two 
public trustees for the Medicare and Social Security Trusts recently challenged 
the evolving conventional wisdom on the potential for ACA to save money over the
 next decade. Charles Blahous, a senior research fellow at the George Mason University
Mercatus Center recently argued in the Washington Post [http://r20.rs6.net/tn.jsp?e=001FlfP3jzFpuOAVt6gh5AgvSrfakjf0Jy4djd9kW8hYq5OIaUux-qyHav8oUyNOMIh41_GONcds6BCNlnh_w_rL-R1kuD257fdHEUd6lYkZGnMafuytNE_p6CJOo8_U-cU1z3uHXH3MZoB9TVA2qTk6Vueu7-QesmtAkyfOF25nttCmINcH-wEvQIyDvyNPXTvKewS2DmfClPzvv80Q__E1NdEJIDVw1Ck8quCSOCkHfM=]
that the ACA "will actually add more than $340 billion to the nation's budget woes
over the next decade." His arguments suggest that the federal accounting practices
used by the government have obscured the true fiscal impact of the ACA. At the same
time, the Congressional Budget Office (CBO), which is the government's non-partisan
fiscal umpire, reported in its estimates last year that repealing the law actually
would increase deficits by $210 billion from 2012-2021.

ICD-10 Implementation Delayed - Last week, Secretary Kathleen Sebelius (HHS) announced
a proposed rule [http://r20.rs6.net/tn.jsp?e=001FlfP3jzFpuNQ0TQesF_MAEAujsxkfVoB37LY3MeBWr5M40EN-Z6lJ15NAX3wvtajNceSEzTtpSCH0y6NoLC-uIJynNP8MUg5S1yvQrzmfIjwTEinAQVjaESOH6gyPSOjDWsZVCWeLUpRzvR_9OkKcAG5LaOlhUaXd6zvZAKGfRdFSIRo4dgiYrP_KQzo5e1ywIR6SM3JS82kWlClDLYsCKRhwPrrXUvY-fMM-EfwrtJ3QOahAg8KURtqah8acD2cmABmv1DBvu8Z0Yz-FdDyzbfw7Eb63IODH4-27EM-DfmVhJ77_KSeF-hvfIMIL5cAqsYjJj_FdFAFRBnlYwkGacNexdqIIx1jMn15zBNC53NVVnJswHf0wve_7SPBuhmmzu7SicrcvUYJspZzQA-w3SyHTECh0UWbodpdFhcvdCEVpunD3H7TUnCqMmciIzblzo9CHcWfo21ms_OGoUYWpauOWCiehA4wCwPK4b1VS5pMtuacYC2gH5lZ1ENtYAvJlEmfYMfdAztHROBKkyYY4ybiSM3HN2JpGEgXjTThZW2vUOM98x7uC8Vl_vttBZUWK_1EQ5api84=]
that would delay the compliance date for ICD-10 for one year from October 1, 2013
to October 1, 2014. The change in the ICD-10 compliance date came as an addendum
 to a proposed rule that would adopt a standard for a unique health plan identifier
(HPID), create a data element that would serve as an "other entity" identifier (OEID)
and add a National Provider Identifier (NPI) requirement to existing rules and regulations.
For further information on the changes embedded in the proposed rule consult the
 ICD-10 fact sheet [http://r20.rs6.net/tn.jsp?e=001FlfP3jzFpuO5eCgod2y8cjzPpM78ejrYwlOioTR-qVpFf269BFT7wgDOqEvhXbTOVAllA8uCoFpLyHro8uO3IiyFslJms5CaICfodRmP83dErdQE71UVDKi4jBKODUU_S5sdk5jY2UlJTcelLrAZnUZxTqCeO689R6BpFPizq5n_vmq4YsBpiobGlnLx51PijuIIa1yG_0av_ev2NdwtmiQYcruCr3qZOjdZHzJ1N6tq-n0IEJ-xJMiDgZFssRIX3Ei_TKW-HKQUK7W6YTdT2QQ7YiG7wEOEHBIo3RQKVQ5QR-k0EbAnZoYBENPfBxiCdn4Dk-QUsTy5J_AaPr0R40BbaWQCWavZ7B1LtNNpMhkXBHHNb7VhCkJ9hw-iSFdvArsc591_3u9BBgCz9N9DgIyJ6zQ6aVd9EBLimlwLbq3JyvPG06tXzjSHMVD8Fhi2gkUeSlSM4TDWnUompwA-55PUp216DcY8DBfplygLetUy7ItO2LI7sTkaeNAIN9FGOpD_V6Tk1wIYNZFsRLyd8nSAnL9HlSRE2nkKPrTp2gt8kTWqgJMR_nqlIe8oehzd].

The proposed delay in the implementation of ICD-10 comes as a number of provider
 groups expressed serious concerns about their ability to meet the October 1, 2013
compliance date previously set forth by HHS. The rationale for delay provided by
 CMS and HHS relates to their agreement that a delay would give providers and other
covered entities more time to prepare and fully test their systems to ensure a smooth
and coordinated transition among all industry segments.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Moving From Jeopardy to Reality:

IBM Watson Takes On Healthcare

Can IBM's Watson supercomputer truly help physicians

with tough diagnoses?

Several weeks ago, Dr. Fill, a computer program designed to solve crossword puzzles,
turned heads at the American Crossword Tournament in Brooklyn, N.Y. Like IBM's chess-playing
supercomputer, Deep Blue, Dr. Fill crunches numbers faster than any human ever could.
By contrast, IBM's Watson--the firm's latest supercomputer that beat the Jeopardy!
champions Ken Jennings and Brad Rutter in 2011--tackles problems with even more 
finesse than Dr. Fill. Watson understands language and how it works. And, what's
 even more exciting? The IBM folks have put together an "IBM Watson Healthcare" 
team. So, in the next couple of years, we should expect a Watson-esque version of
the show down on Jeopardy!

The feat--performed through the resources of natural language processing [http://r20.rs6.net/tn.jsp?e=001FlfP3jzFpuMTn6eJFYv0B9PGK8Fj8cT2DAcpGfuBeJ1zXtTNiheD5j5l5R35BMD_3VSCr4oQ1dGlE2E8uisMR9uTjRyc36Bk5BC-utE1q8KXpjQ6dIir83-PuIrRegBAR9CoxByuu4nEvcWOaRu5WG1mYcQdWaw5]--has
created quite a buzz in the healthcare community. IBM announced that they are formally
moving into the healthcare space by promoting Watson Healthcare as the ultimate 
clinical decision support (CDS) tool. Unlike Dr. Fill or Deep Blue, Watson Healthcare
can extract meaning from the so-called "unstructured information" (e.g., text, emails,
lab reports, etc.), which has stymied many in the healthcare information technology
(HIT) industry in the past. At the annual HIMSS conference in February, Dr. Marty
Kohn, IBM Research chief medical scientist of care delivery systems, described how
Watson Healthcare can assist physicians [http://r20.rs6.net/tn.jsp?e=001FlfP3jzFpuOuVE1lnufP6jJQLxW_btT4KMnwmgu2788DByxWag_FMNoTiNwlYE9RrAk4BlRBENQbi9Q_eoOS18DpOwNsPTGYnZOY7RtQXIax2MiYMPbpbDual4km92BgrxqZ3IjLjJYmjEjRZ9kQDxiRxWt8iZWNJHIJjbsmhJWb-GxEwiSrUOOoYayImisf7uH7yv5yxO4=]
with the diagnosis by scouring more than 200 million pages of information in fewer
than 3 seconds.

Dr. Kohn and the IBM Watson Healthcare team see their tool as a major advance in
 clinical decision support and an "enabler of healthcare transformation." However,
many veterans in the HIT industry recognize that technology frequently does not 
live up to its initial hype. In the introduction to his lecture, Kohn even admitted
that everyone thought electronic medical records (EMRs) "were a panacea" back in
 the 1980s, but then realized that no true panacea exists. So, is Watson Healthcare
just a clever marketing move by IBM or does it offer real value for healthcare?

Watson Healthcare is clearly more than a search engine on steroids. It combines 
statistics, machine learning and data mining to offer suggestions that resemble 
answers (NOTE: Alert viewers of Watson's run on Jeopardy! may remember that it actually
gave three answers to each question, ranked by statistical confidence levels). Like
other forms of artificial intelligence, Watson Healthcare can "learn" by examining
the correct answers and remembering sources that are reliable.

Watson is also the latest product in a long line of business intelligence tools 
deployed by IBM. This evolution began decades ago with the analysis of basic data
such as length of stay and other crude data points offered by the healthcare industry.
Hospital executives then developed complex ways to examine structured data (i.e.,
statistics that are easily accessible in spreadsheets and other defined formats).
Finally, hospitals adopted predictive technology, which allowed them to schedule
 the operating room optimally and deploy resources to the right place at the right
time.

However, Watson Healthcare likely will not replace traditional business intelligence
tools because its niche lies in scouring unstructured data, not spreadsheets. When
patients show up in the ER and describe their symptoms, Watson Healthcare scans 
diverse sources of information such as the EMR (e.g., family and patient history,
medications, lab results, etc.), scholarly journals, payer information, insurance
records and pharmaceutical company information. Watson Healthcare can then ask for
more information to refine the suggested diagnosis. The diagnostic suggestions are
based solely on confidence levels, keeping to a minimum the human biases which have
been shown to cause diagnostic errors.This approach keeps the human element at bay
and reduces errors!

IBM expects Watson Healthcare to eventually generate more than $1 billion in annual
revenue which I believe is a vast underestimate of the potential for this tool. 
Several healthcare clients have already purchased the system. Six months ago, IBM
signed a deal with WellPoint [http://r20.rs6.net/tn.jsp?e=001FlfP3jzFpuPP8ENG6nR5A2HZR5fNME2YDR6YiZJDPFEf4XO8V0hrbXQXtE8h6g0eSe1ferY9LnABziWANMsBSznWIY3z97OXRxsVq5QDMHTDVhsCr29G6e3OhfNk7a_gvF7fCfttbYfBK6B_utHxjQ==],
a major healthcare insurer with more than 33 million customers, to provide analytic
services. WellPoint's nurses will use Watson Healthcare for clinical decision support
when they are managing complex clinical cases. If the deal succeeds, WellPoint intends
to expand the program by offering services to its oncologists so that they can query
Watson Healthcare about their most difficult cancer cases. WellPoint is also using
Watson Healthcare to speed authorization of treatments. This may seem like a mundane
task, but by using a computer to cut through this red tape everyone's costs are 
reduced--insurers and physicians alike, who spend on average $85,000 interacting
 with payers each year, again, according to IBM's Dr. Kohn.

In addition, Texas-based Seton Healthcare has tapped Watson Healthcare [http://r20.rs6.net/tn.jsp?e=001FlfP3jzFpuOpE7rEbUE5xvKAUuD5ccj36oTaZGfHPLFOlzXjkKPPuJXV1Ars67S1iXEjMTLls5X1tu_eA-X9o3is48EG45zXXoDnbJgpd8otmt_kBQbucRHBJenSM7urYOICHF4K35awMc-ywZWV4w51BQ4UQgpUzIQfbY1_ccmZ5_QjmQrqLPeBpAvzQUunUVHyphnRatY=]
to delve into why its heart surgery patients keep getting readmitted to their hospitals.
By using the Watson Healthcare system, Seton intends to pore over patient records,
doctor's notes and nurse's notes to find connections on why some patients are being
readmitted to the hospital. For further information on this project, review the 
recent Investor's Business Daily article [http://r20.rs6.net/tn.jsp?e=001FlfP3jzFpuMtMsfNG7clSjdIxJbVKxt1vaab3OT_AnQ60ysUnYRPLmCrGSohO-14VnqyEGI1FP8hzpyfd32aB2SP7bqx6QdkySA-frTLVm_XxhDlGKroGoy5Ozbq92fXO6qtBS6WWRn3Z_HzOWl-JtvXDWDJi67FXplek4rKRzgDsi4H4Bu71nT9RvUFW-mQ].The
Seton-IBM project was also discussed at a forum of physicians hosted by  Dearborn
Advisors, LLC [http://r20.rs6.net/tn.jsp?e=001FlfP3jzFpuOR33ryRo_eokPKqSf9aaXS1_BGr1nmq6Q-9gkMu5CX2Xykh1dRZa9Fa0zxB-HDENEKI0UPzAy20tMBuQT1Tf6nns7KxWOLugemimJiuIWCzeN-VWuYWQf9tSPy6GcjCSZxmKLAvJKWZA==],
a Fickenscher Files sponsor. Watson Healthcare is one of several business intelligence
tools that Seton and its parent company, Ascension Health, will be relying on to
 improve clinical quality.

As a technophile, I view IBM's move into healthcare and the Watson Healthcare systems
with a high degree of optimism. However, we will not solve the problems in healthcare
with technology alone. A good example is the ubiquitous problem of hospital readmissions.
As I mentioned in a prior Fickenscher Files report [http://r20.rs6.net/tn.jsp?e=001FlfP3jzFpuMDHTecaWmyDt25duaKvyhqfvQflUMi9kKLRXoF6G4ksafs1FviBAdR0a1NiAs60IupfDdkLUh48EDFlMr8lToaS6nAks3bg6Ss9ZYzVTMPjo44RYIi9jeIGUDpmI1_ivK3KWMX9OVMGRxyZlMH9mzvzb0wsPK2P4zNO-OKEU-0TYDtMD_kvPLy4KewrLHPSr-YW1jD4x2Xgg3YKw4H8x2zOQ8MH1IcIKbBwLZE8n-jDQ==],hospital
readmission problems also require low-tech answers--caregivers who reach out, pay
attention to and educate patients about their conditions. Technology is no panacea,
but it can be a step in the right direction.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The Trouble with Hospitals

More on the move of care from institutions to living rooms ...

The American hospital is a cornerstone of the care delivery approach in the United
States. Most Americans are now born in hospitals. They are the places we are taken
when we have injuries and when serious disease or sickness strikes. The American
 Hospital Association (AHA) reports that in 2011 there were 5,754 registered hospitals
with more than 942,000 hospital beds accounting for 36,915,331 admissions in the
 U.S. Yes, about 1 in 10 of all Americans was admitted to a hospital last year.

I first became interested in the impact of hospitals back in my rural health days
in the 1980s at the University of North Dakota. In addition to their contribution
as the hub for healthcare services, we also came to recognize that the general hospitals
also contribute substantially to local economies.  And, that is not just a rural
 phenomenon. It applies to urban areas, too. It is part of the reason that communities
hang on to their hospitals. In fact, less than one-half of the American health care
dollar is expended on hospital services or just over $750 billion in 2011.

Despite the important position of the hospital as a hub for local healthcare services,
the hospital as an institution is undergoing massive, transformative change.  It
 is estimated that by 2020 one in three hospitals will close or reorganize into 
an entirely different type of health care service provider. So, why is this happening
and what does it portend?

First, the cost of healthcare is crippling the American economy. It is imperative
that we need to better control the continuing escalation of healthcare costs in 
America. The average American worker costs his employer in excess of $12,000 annually
in health care benefits. The costs are increasing by more than 10 percent per year.
 American businesses are at a competitive disadvantage in the global marketplace
 because of continuing escalation in healthcare costs. State budgets are also experiencing
the crush of healthcare costs because of the Medicare and Medicaid entitlement programs

Second, hospitals are not necessarily safe places! Three times as many people die
every year due to medical errors in hospitals as die on our highways--nearly 100,000
deaths compared to 34,000. The Journal of the American Medical Association (JAMA)
recently reported that of the 100,000 people who die annually in hospitals from 
medical errors about 80,000 die from hospital acquired infections, many of which
 can be prevented. The result? One out of every 370 people admitted to a hospital
dies due to medical errors--not a great track record for a healthcare organization.
By comparison, it would take about 200 747 airplanes to crash annually to equal 
100,000 preventable deaths. Can you imagine the public outcry that would ensue if
a 747 crashed every day for 200 consecutive days in the U.S.?

Third, technology is changing everything. In the past, the hospital contained the
technology that supported the care delivery process. Now, the technology is allowing
us to move care out of the institution.  My article "Wearable Devices Continue to
Evolve" illustrated how the use of a new device can change the very nature of where
and how care can be delivered. I recently learned about another company that has
 a similar patch device that not only captures vital signs, but also obtains temperature,
basic electrolytes and other core functions. Suddenly, the notion of taking care
 of patients in the home is no longer a concept--it's becoming a reality.

Fourth, health care reform is making connectivity and comparability a cornerstone
of transparency commonplace in healthcare.  Within the next few years, any American
considering an elective hospital stay will simply go online to compare hospitals
 relative to infection rates, degrees of surgical success and many other metrics.

We've learned to comparison shop by going to Target, Wal-Mart and Best Buy websites
to find that perfect TV. Why can't we do the same thing in healthcare? We can, and,
we will. Not only that, but Americans are expecting the best care for every care.
If one has prostate cancer, the patient will come armed with the latest data and
 protocols for managing the problem and asking the question, "Why aren't you following
this protocol?" Transparency will drive the quality, service and cost of care provided
by hospitals. Some will survive and some will not.

It is estimated that about one-third of U.S. hospitals will not cross the 2020 finish
line as winners. David Houle, a futurist, has argued this point and I think he's
 right. The hub of the healthcare system is changing. It's no longer the big building
down the road. It's your living room.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The Weekly Whisk

Musings from a foodie ...

I was traveling in Dallas this past week and the rural folks were meeting at the
 Omni in the downtown area. The Omni is sporting a new restaurant, Texas Spice, 
which is supposedly the only "green" restaurant in Dallas. They told me that all
 of the food sources are within 250 miles and that the restaurant is a "certified
green at the gold level" restaurant. For Dallas, I anticipate that it represents
 a fairly high rating.  While the effort was good, there were some improvements 
to be made. []

Chef Corey Garrison is the main purveyor of foods. The menu was on the eclectic 
side and represented a south-of-the-border-esque style. I opted for the buffet which
had an assortment of salads, the obligatory mac-and-cheese (albeit, spicy), dusted
catfish and an assortment of other meats.  The Chipotle Caesar dressing was markedly
spiced, but it wasn't subtle and perhaps a bit too much in your face.
The buffet had been sitting far too long and while this is not a taste problem, 
it distracted from the overall quality of the meal. The standout on the buffet, 
however, was the chicken dressed in a Humboldt Blue Cheese sauce--it was fabulous.
But, aside from the chicken, the buffet was not notable. It was good for nourishment,
but not for excitement. If you get to Dallas, need food quick bite and happen to
 be staying at the Omni, then go for it. Otherwise, if you're on a culinary hunt,
keep looking. Texas Spice Restaurant & Bar [http://r20.rs6.net/tn.jsp?e=001FlfP3jzFpuPVfaOiELL4_vERw-jkKS6AARXyYI_JxYULtk2zraXHpK8tdzNYb_L2jcq8ScOHZdIe-nWK5QliCQ57PizR2loqKtVwSy2m-9pg9un0O5MnxTmbLIwAdYmK_sbByOGMCDlA2W10A-xG7jMGhsPapbnD3nBVFY9udFYGGgFzgJSlhw==]
- 555 South Lamar Street - Dallas, TX 75202 - (214-652-4814).
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The Good, The Bad, and The Ugly

The ongoing saga ...

The Good - The prelims are now over.  It's Obama versus Romney.  Let the games begin!

The Bad - The number of unemployed sputtered along and did not shrink as rapidly
 as predicted.  The end result is that the recovery is taking its time.  One moment
we think the economy is improving and the next, it's not.  Although the general 
trends seem positive, it's frustrating. It would be nice if the recovery was faster.

The Ugly - In a report issued by the Department of Health and Human Services, nursing
homes were called out for their lack of planning related to emergency preparedness
including lack of coordination with local emergency management and inadequate transportation
support.  And, again, I call out the obvious ugly--Syria, Syria, Syria. Enough said.
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In This Edition

Quote of the Week
Consulo Indicium
Moving from Jeopardy to Reality
The Trouble with Hospitals
The Weekly Whisk
The Good, The Bad,  and The Ugly

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