Subject: News from Dr. Kevin Fickenscher
From: "The Fickenscher Files" <[email-masked]>
To: <[email-masked]>
Date: Tue, 6 Dec 2016 11:01:34 -0500 (EST)

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The Fickenscher Files [http://r20.rs6.net/tn.jsp?f=001l2ngh4pJyhoO7MpMzat6sJc6Kg2qru78LUNnWKdfan3CtWtxTXfBWnklVk3Z4IRXt_lu-VqbBtTV0rQVkXSaFSKydv7RY7_KhZBp68NG4-yDvfwIsTYHpLLbq1ZvPMTa1d40GLMzdcCd0U5R8yOrMbXOsNRv4Sat_ZnCteV7ndt7SXyJ91LNbAcnTB4670t6&c=J2uBN1tg1XEXUjU0S5-3Z7vMEytFRA0DVxb2TwNO8Okkyx9BR91Zxg==&ch=3NY2JYomJ3qdJdJKH4__ajEAdU8RZKbu-mF2gSsuGgnz-xX62E6Uqg==]
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The Fickenscher Files, Vol. 4, Issue 16
Kevin M. Fickenscher [http://r20.rs6.net/tn.jsp?f=001l2ngh4pJyhoO7MpMzat6sJc6Kg2qru78LUNnWKdfan3CtWtxTXfBWv3kKWXZQ0LET5rClQ8qyH3XGYS1WD2Ctd94ht_u1_0aBIV9585QFtkX_cvDup0EdbPwV6fXueQB3wfeYmdzAG2q6l-756tUuifajp0VmBcpU6Bvx0pec_df1txahwMkYE0gEXv8YrOHT2WuenG0mQ5JRoM1Rl_EQ8aaCsbxP9OLyv8QL4AYCp9v0yPBIjZuicLaN2-2GUbyr98FJOfNVis=&c=J2uBN1tg1XEXUjU0S5-3Z7vMEytFRA0DVxb2TwNO8Okkyx9BR91Zxg==&ch=3NY2JYomJ3qdJdJKH4__ajEAdU8RZKbu-mF2gSsuGgnz-xX62E6Uqg==],
MD, CPE, FACPE, FAAFP
@MDKev
A compilation of information, thoughts, and perspectives on the issues of the day
related to healthcare, technology, and beyond - including the latest culinary explorations.
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Quote(s) Of The Week
"[The industry must] work together to discover better ways to evaluate and measure
what we are doing to make patient-driven care better today and in the future."
- John Noseworthy, MD CEO, Mayo Clinic on improving measures of health care quality
"Now more than ever we need to focus on encouraging people to enter the field of
 medicine to be innovators of medicine and to strive to provide care for the many
who do not have access to care."
- Kelly Thibert, President of the American Medical Student Association on the future
of medicine
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An Initial Thought
Thoughts from Others for your Consideration...
I'm a fond admirer of David Whyte - a very thoughtful and, at times, provocative
 poet.  I came to know him during my tenure on the Boards of several different Catholic
health care systems.  The Sisters have always been incredibly good at getting the
laity to consider alternative perspectives and David Whyte was one of the favored
speakers at the many national assemblies that I attended.  More recently, a close
friend of mine forwarded a citation from Mr. Whyte's website on the results of the
recent elections here in the United States [http://r20.rs6.net/tn.jsp?f=001l2ngh4pJyhoO7MpMzat6sJc6Kg2qru78LUNnWKdfan3CtWtxTXfBWgx-l2vimrG6puPg2u49lTUHiE4-OOhH680whQEPQCyYn1ukC6k3BM39MhQodOp_ZLsjfN2ZG9pJfCfbWV5x5sGp0hcPGew6fUj-S8390MfGvqr8t6fb61HWXdgLjecgw4781wC5LqzsjlSPTyHElLo=&c=J2uBN1tg1XEXUjU0S5-3Z7vMEytFRA0DVxb2TwNO8Okkyx9BR91Zxg==&ch=3NY2JYomJ3qdJdJKH4__ajEAdU8RZKbu-mF2gSsuGgnz-xX62E6Uqg==].
 I thought I would pass along his very clear admonition to all of us to consider
 the full spectrum on the meaning of the election results.  Enjoy the read and consider
what it means for you both individually and as a member of society.  Mr. Whyte -
 it seems to me - offers a respite of hope on how our society will adapt to the 
changes we will no doubt be witnessing in the coming months and years as a result
of the election.
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Consulo Indicium
Information for your Consideration...
Depression and Mild Traumatic Brain Injury (mTBI) - There is yet another study released
in the last week by researchers from Walter Reed National Military Medical Center
on the sequelae our Veterans in the aftermath of trauma experience during war.  
The study found new links between mTBI and depression which were unsettling.  It
 compared those with a definitive diagnosis of mTBI with those of a control group
without evidence of any trauma.  A large proportion of the affected Vets experienced
"moderate to severe depression" with brain imagery findings also showing disrupted
cognitive function consistent with mTBI.  The implications are significant since
 more than 350,000 service Veterans have been diagnosed with mTBI since 2000.
Now, About That Job? - The jobs front has been at the forefront of discussions in
the nation since the Great Recession.  In fact, the recent election results are 
a tribute to the dismay that exists in much of the heartland of America as a result
of jobs lost.  According to a recent editorial by Steven Rattner [http://r20.rs6.net/tn.jsp?f=001l2ngh4pJyhoO7MpMzat6sJc6Kg2qru78LUNnWKdfan3CtWtxTXfBWgx-l2vimrG6oTZv6L6K0goxL_nv1AB-puMQ2H3406RWY3wdoxT30wxCISY8Cd6YNCwrHfKIBdrsrIEHPuK5GB9yQUi0jE-KiN7HEg6C4xa4vkok4MM6rf6FsTzNWbzdwQcnh0E6m_5r&c=J2uBN1tg1XEXUjU0S5-3Z7vMEytFRA0DVxb2TwNO8Okkyx9BR91Zxg==&ch=3NY2JYomJ3qdJdJKH4__ajEAdU8RZKbu-mF2gSsuGgnz-xX62E6Uqg==]
("Can Tweets Bring Back Real Jobs?") manufacturing jobs peaked in 1979 at 19.6 million
jobs.  Today, those same jobs only represent about 12.3 million jobs.  The end result
is that we are seeing a hollowing out of the traditional, high paying jobs in manufacturing
which are being replaced by more service oriented jobs.  For example, in 2016 there
has been an additional net decline of 62,000 manufacturing jobs in the face of 1.8
million new jobs in other sectors.
Why the trend?  It's pretty clear that it relates to costs.  In 2015, the typical
factory worker in the USA earned $37.71 per hour versus his Mexican counterpart 
(for comparison) at $5.90 per hour.  That cost difference in the face of productivity
demands for keeping costs down is the major factory for manufacturing jobs moving
overseas.
But, there may be some hope IF we - as a society - do the right thing.  And, what
might that be?  I found this report [http://r20.rs6.net/tn.jsp?f=001l2ngh4pJyhoO7MpMzat6sJc6Kg2qru78LUNnWKdfan3CtWtxTXfBWgx-l2vimrG6pXv9IsumZUunVs8pINbCddB2BOoq-GYqsoCt4A4-8yxBvjnNCWaxiZhFF_slZXAHpvQlxn9cnRFvV9ZzGSePYgltJy6nYYzgLNecDEbSG88a1GPB5XH9tjovts8qcCoW&c=J2uBN1tg1XEXUjU0S5-3Z7vMEytFRA0DVxb2TwNO8Okkyx9BR91Zxg==&ch=3NY2JYomJ3qdJdJKH4__ajEAdU8RZKbu-mF2gSsuGgnz-xX62E6Uqg==]
issued by the Georgetown's Center on Education and the Workforce (CEW) in one of
 my reading piles (it's several years old, I offer sheepishly L but, at least it's
not "fake news" J).  Regardless, the report noted that we are going to see 31 million
jobs open up due to the retirement of baby boomers with another 24 million new jobs
created as well by 2020.  Now the report did not take into account the recent populist
leanings nor the potential demise of globalization.  But, it did reveal a shortfall
of 5 million workers.  However, of particular importance was the side note that 
the shortage will be among those with post-secondary education and training.
In fact, 4 out of 5 of the fastest growing occupations were in areas that were not
that surprising including: technical and professional health care workers, STEM,
 education, community services, information technology and government.  The report
noted that 80% of the jobs coming available in these sectors will require post-secondary
education. The one exception to the rule was in health care where only 59% of jobs
will require some degree of post-secondary education and training.  In some respects
- that makes sense because for a number of years now the field has been debating
 how we are going to actually "deliver" care with a looming shortage of actual "care
delivery" members on the health care team.
And, the implications?  Well, it seems to me that we need to redouble our efforts
in providing education and support for individuals who want to either enter or transition
to these fields. As I look at the shortage areas, the work entailed by these workers
is ubiquitous throughout all of America.  So, it seems that investing in education
for individuals who want to either transition to or begin anew in these fields would
make a lot of sense.  In the current political environment, the other obvious point
is that we should not be dishonest with workers whose jobs are disappearing.  Suggesting
that somehow jobs are going to magically reappear in a very clear environmental 
trend of a shift from manufacturing and production to service and delivery is not
a service to these workers.
It does not seem to me that there is going to be some magical renaissance just around
the corner, where jobs are going to suddenly reappear.  Rather, as a society, we
 should redouble our efforts to provide education and training in fields where jobs
are growing.  From my perspective, Congress should get busy by developing and funding
a national jobs retraining program geared towards lifting up those who would like
to work in health care, education, science, IT or government.  Wouldn't that be 
more honest and actually solve a problem?  And, simultaneously, wouldn't it be good
for society?  What am I missing?
The Impedance Of Insufficient Interoperability - Yet, again, there was a recent 
"Aha" which seems to repeat itself every couple of months. Providers, patients, 
and precision medicine researchers came together in their Annual Report [http://r20.rs6.net/tn.jsp?f=001l2ngh4pJyhoO7MpMzat6sJc6Kg2qru78LUNnWKdfan3CtWtxTXfBWgx-l2vimrG6dG9w9QN-j5LVB7A8HGzi3Kv1kFUKX3n4GPsZEjmezqpuoMZwXi7MMdSQ_CPVb52Wk1odwKhY1TmWlY8Dk3KX4mWf6ljsj_9tIJx0A6j4ELGU6kd15Q4T5uYBZfCKoaDq8oSxR3e2hV2OBBa3VXzewzYeDcJOmLyeLwpIh-_UoRepPw3jBZHYnBEqTx2kp0dNGhXXpXaVeFrmRZ8r3UCgqoGdecHSUueG&c=J2uBN1tg1XEXUjU0S5-3Z7vMEytFRA0DVxb2TwNO8Okkyx9BR91Zxg==&ch=3NY2JYomJ3qdJdJKH4__ajEAdU8RZKbu-mF2gSsuGgnz-xX62E6Uqg==]
of the President's Cancer Panel which declared that seamless health data interoperability
will be required to find cures for cancer.  While there are some exciting projects
that the federal government is sponsoring (e.g. the NIH Data Commons [http://r20.rs6.net/tn.jsp?f=001l2ngh4pJyhoO7MpMzat6sJc6Kg2qru78LUNnWKdfan3CtWtxTXfBWgx-l2vimrG6m11eQEebsjSNZRU2CYHgXONaw5DmQSraD-yiHCRYuBnZGTH_4GMnZShVbnlypFD7jjkRcMbr-rZR8FGTKigRSiO_IQgZMV7G_1t2VYkRwn8=&c=J2uBN1tg1XEXUjU0S5-3Z7vMEytFRA0DVxb2TwNO8Okkyx9BR91Zxg==&ch=3NY2JYomJ3qdJdJKH4__ajEAdU8RZKbu-mF2gSsuGgnz-xX62E6Uqg==]),
they represent only a small step in the right direction for what is needed.  The
 report notes that health IT could - in fact - be one of the more effective weapons
in the fight against cancer and other serious diseases.  However, data interoperability,
patient access to data, and the ongoing fragmentation of our nation's research environment
are preventing us from reaching solutions, faster, better, quicker - and, most likely
- at less cost. In fact, the lack of interoperability is holding back stakeholders
from making key breakthroughs in care delivery. Barbara Rimer, DrPH, a noted researcher,
in announcing the report stated, "...many patients cannot access or share their 
own health information; care teams experience electronic health record fatigue and
frustration due to lack of interoperability, among other challenges; and researchers
do not have a central location to compile, analyze, or even access critical data."
The item to note for those of you who are not technophiles is that the core problem
is NOT a technical issue.  It is possible to have interoperability.  It is possible
to overcome all of the variables that are holding society up from accelerating solutions
for cancer and other chronic health care concerns.  But, to solve the problem we
 need enough members of the health care and lay communities to stand up and say 
"Enough is enough!" to drive a change.  Today, data silos are too frequently accepted
as a norm.  It will not change until enough people say, "Stop!".  One feature of
 the evolving health care system - the shift from volume- to value-based reimbursement
- will clearly drive us in the right direction.  But, we await the new course which
is to be offered up by the Republicans as the "repeal and replace" ObamaCare.  Incentives
are not inconsequential and will likely determine whether we solve this problem 
in the shorter term (the optimistic view) or the longer term (the pessimistic view).
It's clear that our nation's health information exchange (HIE) capabilities (or,
 interoperability) are at the core of the problem. Technically, if we encouraged
 through incentives or demanded through policy the adoption of standards-based tools
and APIs [http://r20.rs6.net/tn.jsp?f=001l2ngh4pJyhoO7MpMzat6sJc6Kg2qru78LUNnWKdfan3CtWtxTXfBWgx-l2vimrG6wV282uM44_cJiSS0xXNJycQvAQsMUicqQWpxlhvZRKKa1SuGIjdKyDT_7ZZ7w2DBgdylTHtlO1d9CfO__6dIN9qHq8qisIF_y-_AC9EOesrSFdQ2x_BAbuczxsIoYcZAroEPwVL902mwNVMLNL-OY6IdcpZ4aYoh3pjiwhTFss7vlk85a5mIZHyEckvnNVo-qhhC4arwl7g=&c=J2uBN1tg1XEXUjU0S5-3Z7vMEytFRA0DVxb2TwNO8Okkyx9BR91Zxg==&ch=3NY2JYomJ3qdJdJKH4__ajEAdU8RZKbu-mF2gSsuGgnz-xX62E6Uqg==]
would accelerate solving the problem. There are some other considerations as well.
 For example, the report supports initiatives to expand broadband access for underserved
areas.  We need to pull data together from disparate systems.  For example, enhancing
the care delivery capability for cancer patients involves access to information 
on housing, medication utilization, social services and a whole host of areas that
are not traditionally considered in "interoperability" discussions.  It's far more
than the electronic health record.  But, again, it can be solved.  Think about it...
Trump Charts A Course - President-elect Donald Trump (R) set a course for action
 that rings true with his stated commitment to "repeal and replace" the maligned
 ObamaCare program.  Representative Tom Price (R-Ga.) - an orthopedic surgeon and
physician executive - was announced as Trump's pick to lead DHHS and Seema Verma
 - a very respected conservative health care leader was announced as his pick for
serving as the Centers for Medicare and Medicaid Services (CMS) Administrator.  
Under Governor Mike Pence (R-IN) - now the Vice President-elect - she led the Indiana
State Medicaid program and by all accounts has done an excellent job.
While both require Senate confirmation, it's likely that confirmation will occur.
 Price has been an ardent opponent of the ObamaCare program.  Over the last several
years, Price has introduced his replacement bill (HR 2300 [http://r20.rs6.net/tn.jsp?f=001l2ngh4pJyhoO7MpMzat6sJc6Kg2qru78LUNnWKdfan3CtWtxTXfBWgx-l2vimrG6Adqrfllo46h09zN4-gTJ7p4Q8DZZFZjgvNQmOGCO4jD_ZRfunb3m8VTbYpJFv6qqLdtmSwGKkPjvRbbteHKiHgmEKq6_HwsnF28IybtTCusP8GwNU8NautRTlkcIfW6QHngs1myWcyRUbePCmdn1yYWCx7uAc4x3I2rG981GLzw=&c=J2uBN1tg1XEXUjU0S5-3Z7vMEytFRA0DVxb2TwNO8Okkyx9BR91Zxg==&ch=3NY2JYomJ3qdJdJKH4__ajEAdU8RZKbu-mF2gSsuGgnz-xX62E6Uqg==])
- the Empowering Patients First Act - which he has introduced every year since 2009.
 It would repeal the ACA and provide tax credits for USA residents to purchase health
coverage based on an individual's age instead of their income.  His bill would also
make it easier for insurers to sell health insurance across state lines and would
use a modified state incentive payment or block grant type of plan.  His plan calls
for about $3 billion in grants to subsidize high-risk pools to provide coverage 
for individuals with pre-existing conditions. There is considerable controversy 
on the "high-risk pools" concept which philosophically goes in a different direction
than ObamaCare. He also proposes that beneficiaries would be required to be "able-bodied"
although the details are unclear.
Price's plan would also offer tax credits for those individuals who want to opt 
out of Medicaid, Medicare, or Veterans Affairs coverage and use those credits to
 purchase private plans, if desired. And, finally - at the macro level - he supports
a move to shift Medicare to a "defined contribution" model rather than a "defined
benefit" plan.  Expect considerable blow back from the elder community on that one.
 If we thought the insurance companies were mobilized around Clinton I with their
commercials about "Harry and Louise" - I would bet the elders will be of a similar
spirit in efforts to "take away" their health care plan.
Before joining Congress, Price worked in private practice for nearly 20 years as
 an orthopedic surgeon.  He then moved in physician leadership roles as the medical
director for orthopedics at Grady Memorial Hospital in Atlanta. He currently serves
as the Chair of the House Budget Committee and is a Member of the Health Subcommittee
on the House Ways and Means Committee. The last physician to lead DHHS was Louis
 Sullivan, MD who led from 1989 to 1993.  However - unlike Dr. Sullivan - Dr. Price
does not hold as much bi-partisan support for his nomination. Witness to the divide
among members of the House of Medicine (i.e. the American Medical Association) is
a letter sent to the AMA Board of Directors [http://r20.rs6.net/tn.jsp?f=001l2ngh4pJyhoO7MpMzat6sJc6Kg2qru78LUNnWKdfan3CtWtxTXfBWgx-l2vimrG6kz5WkQu-k5SdSntn9A9-OBboFW4QKWcWCk8SXt4LMgD7WnO8Me46O6dMEw0XoMd7Ipa2A1ReJXoAiFCXQaNXiEe_ogW2h1g8Sn5Ea4ycEQHBstJevaiJmbpjWGM0a9NskfSzHqhllxcnwPMP-fDzrbDMx5Whib0SRGEQuw8vpMExLlsU7_GhckSSV-BvHDJ32C0jwOfz4goGrGEKP2X-eA-5xmAikqKYe0cibyaKkqCczCnPrZLPbqDdXdkUOxEh6ZZ7hboQvuZHZSO0y-Kouta01FdXcQPNIj1Q7RUvNNMWNeXqyaxiWtC3DW2ByIDKIlCQxDVZmpY40DUdr6MuWl0Xp6_r4tUMkHbZwY_RadW2XglKuGaf_Z45PhtYhGlj-p5l9Mc63npVILA0xjEcJGUsIDa1CqZwdlcgEnWoICwhIVOqmhV6Lwz2VRr1Tm5Q9sAgJPy5maOZeEHCUQEy-APX64jXG6n3b9OAE6MBGq0EBNfnBzFo3vQxcAxZNc9otZ87OHKYXwdWQ7BCd5dZ50aMfXqY0GwjNr1iDP13rlHj9iJ5qbOMOvfieT_oilfidppYa-Vbsdo=&c=J2uBN1tg1XEXUjU0S5-3Z7vMEytFRA0DVxb2TwNO8Okkyx9BR91Zxg==&ch=3NY2JYomJ3qdJdJKH4__ajEAdU8RZKbu-mF2gSsuGgnz-xX62E6Uqg==]
and, which is being circulated among members on questions related to the "endorsement"
of Dr. Price's appointment to the DHHS Secretary position.  The letter noted that
members were "disappointed by our AMA's enthusiastic endorsement of Dr. Tom Price
for U.S. Secretary of Health and Human Services."  The letter goes on to note that
Dr. Price has been a strong opponent of "so many ...clearly delineated AMA policy"
positions.
On the other hand, Seema Verma seems to carry a fair amount of bi-partisan support.
 While a recognized conservative, she is also very "solutions focused".  In the 
state of Indiana, she worked with Pence to help the state expand [http://r20.rs6.net/tn.jsp?f=001l2ngh4pJyhoO7MpMzat6sJc6Kg2qru78LUNnWKdfan3CtWtxTXfBWgx-l2vimrG6Fyvbc2kNZj7sH1dxQ1cukXtalSkfyVL1bbyiCxiqb0yHtbbxSC6AMh3QG9gyDfkiXtLIU_wE0kLqB1DtkcZUogQP6AHACtRHE5dKK-ibH6dijIMbOGkaXecw_4w6vy38Nb0p24uXNqnn5ceCwFgb9hJwVze0M7Nm7jSR2KpENEBAWqt27UXwsuIzr4yuVteCII7YQJESrxCABnJQC5SuFQ==&c=J2uBN1tg1XEXUjU0S5-3Z7vMEytFRA0DVxb2TwNO8Okkyx9BR91Zxg==&ch=3NY2JYomJ3qdJdJKH4__ajEAdU8RZKbu-mF2gSsuGgnz-xX62E6Uqg==]
its Medicaid program under the waivers allowed under ObamaCare. In fact, she's been
quite active as a consultant to other Republican states in designing programs that
include conservative programs such as employment programs and health savings accounts
for their Medicaid programs.
In announcing the two selections, Trump noted that "Price and Seema Verma are the
dream team that will transform our health care system for the benefit of all Americans".
 We shall see...
More Merger Mania In The Making - Health care mergers are making the news [http://r20.rs6.net/tn.jsp?f=001l2ngh4pJyhoO7MpMzat6sJc6Kg2qru78LUNnWKdfan3CtWtxTXfBWgx-l2vimrG6SDJpEIxwR0Pv3ymmBm7V8jzVZKB-x5Rdi0PEhJEFVkM_zYTgnchFFnrYHI8UgZDy1oD39t8Ylq5O_xKRcvSqXggldelXvDQq7R7JCUOPTJnJpVDN85eljzATOh79YUy61FTz2RHFWwI3x-0H1VRLNFm4kNQI19iMis7YLBZvBo3J8fwhgTAXNFMIUrN3Kij8K5Ke1Q-A97ve_S2-WUkGgLFMkDfoagt-RGrlvNHSXqLpNhRkODA7nulUcMWFqA5KYAhSo0_8RlcuD2u9GcBpkZcux9r9z0mt3DWb3Q5HSFU=&c=J2uBN1tg1XEXUjU0S5-3Z7vMEytFRA0DVxb2TwNO8Okkyx9BR91Zxg==&ch=3NY2JYomJ3qdJdJKH4__ajEAdU8RZKbu-mF2gSsuGgnz-xX62E6Uqg==].
 While proposed health insurance mega-mergers with the likes of Anthem [http://r20.rs6.net/tn.jsp?f=001l2ngh4pJyhoO7MpMzat6sJc6Kg2qru78LUNnWKdfan3CtWtxTXfBWgx-l2vimrG69Fs9A6xjiyiAYlaKy67r2UApSBBgWq7reMKoiZjD_BhMTpgRXR6_-gMx2v1lTFfnkPi5IiT2rIJTz19wJEgWWoQgwEhE2tNSgSVaNBsVOJFZuNu95GmDMKENVPglYRO4Yg5soXhlm0gqy-aUvaxEUdEGdaTuL-eR8tlQWSDYC54=&c=J2uBN1tg1XEXUjU0S5-3Z7vMEytFRA0DVxb2TwNO8Okkyx9BR91Zxg==&ch=3NY2JYomJ3qdJdJKH4__ajEAdU8RZKbu-mF2gSsuGgnz-xX62E6Uqg==]
and Cigna [http://r20.rs6.net/tn.jsp?f=001l2ngh4pJyhoO7MpMzat6sJc6Kg2qru78LUNnWKdfan3CtWtxTXfBWgx-l2vimrG6wfNbb1ESONLf1t3yuxFMqbpMGzSZMEU9nWG6BmpqHdB0-5OAlzjcqBB7hQiU1t8r0yXR_pa_WLV52HMMnhkoe4GGnP9ySw5alPktJg1M9Lo5U_fCQhfGOQ63jK7bRzcF2fBhY6QJTx7ja17xYrreqXG94mUvDGtd8h2wNegu71I8gavWfyBl8lkWY-9uFVK6hbSPDH5OYtzl3D-Xgnsl56i1pKSq7MGW&c=J2uBN1tg1XEXUjU0S5-3Z7vMEytFRA0DVxb2TwNO8Okkyx9BR91Zxg==&ch=3NY2JYomJ3qdJdJKH4__ajEAdU8RZKbu-mF2gSsuGgnz-xX62E6Uqg==]
coming together are grabbing the headlines because it would shrink the major insurers
from five to three - there are many other parts of the health care industry that
 are equally immersed in merger mania.  It's likely that the new Trump Administration
could recalibrate the approach of the federal government in pursuing health care
 mergers.  For example, Senator Jeff Sessions (R-AL) is the proposed conservative
appointee as Attorney General.  He has historically exhibited a "hands off" philosophy
toward government involvement in regulating business.  Will that extend to changes
in the approach health care?  We don't know...but, likely.
In any case, the Trump Administration will have a major say in how the case between
Anthem and Cigna is pursued which will serve as a guide to future merger agreements.
 Based on "inside the Beltway" discussions, it would appear that the Justice Department
would not necessarily drop its case against the two insurers but, it would probably
be inclined to settle more easily.  In fact, the scuttlebutt among antitrust experts
is that the approach to health care mergers will not change its position from the
current philosophy.
The other part of the equation is the approach of the Federal Trade Commission (FTC)
which has as much to say about mergers as the Justice Department.  For example, 
the FTC - as an independent agency that includes both Republican and Democrats in
its leadership - is less subject to the political preferences of the White House.
At the same time, swings can occur...
Among the many merger discussions occurring around the nation, two of the nation's
largest nonprofit health systems, Catholic Health Initiatives (I am a former Board
member) and Dignity Health (I am a former Chief Medical Officer) have indicated 
that they are pursuing discussions to join forces. But, it's not just the big health
care systems that are engaged in mergers.  Mergers are occurring among many small
independent and group practices as well.  In large measure, these mergers are occurring
in order for health care organizations to have sufficient managerial resources for
responding to the new world as we move from volume-based to value-based reimbursement
models.  The infrastructure required for a value-based care delivery model is quite
different - if you want to be successful - that the old fee-for-service model.
Finally, I suspect that the "repeal and replace" approach of the Republicans to 
the Affordable Care Act is unlikely to modify this trend.  Hospitals and medical
 groups alike are seeing advantages for joining forces to solve problems.  If we
 simply consider the capital required for the new and evolving computer systems 
to provide information to doctors, hospitals and insurers - the need for amortizing
those costs over a larger base makes business sense.  So, long story short - consolidation
is going to continue and, I predict, accelerate.  Stay tuned...
A Useful Tool - The Health IT Dashboard @ ONC - There's a tool on the web that health
care leaders need to be using.  It is the Health IT Dashboard [http://r20.rs6.net/tn.jsp?f=001l2ngh4pJyhoO7MpMzat6sJc6Kg2qru78LUNnWKdfan3CtWtxTXfBWgx-l2vimrG6IVtS3NRyqESsEQMZ6u34V6klCesoMBifwtK1kVDSTC1Jglz2B0PE2qZIEhftkKA8uj2FWnFi0UY-OICg-F1EeAFbJWhGzyHHGljP7iTuVoSXXZbQCMMTaCDd_IoRqeTqUr_4MSMNKYWtLjlqNP_NCvl3RrY8x18ylRn0Ccie_8kcrRH56xCpKmiAk7fpJth71dmObMSCIqY=&c=J2uBN1tg1XEXUjU0S5-3Z7vMEytFRA0DVxb2TwNO8Okkyx9BR91Zxg==&ch=3NY2JYomJ3qdJdJKH4__ajEAdU8RZKbu-mF2gSsuGgnz-xX62E6Uqg==]
developed and supported by the Office of the National Coordinator for Health Information
Technology (ONC).
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The Weekly Whisk
Musings from a foodie...
Last week we had the opportunity to visit Elio's - an Upper East Side Italian eatery
[* * * * *] where we met a friend.  I had requested some "good pasta" and, boy -
 did he come through.  I was late after an interminably long cab ride from New York
Penn Central because I wasn't paying attention (shame on me!!).  But, after my arrival,
all of my angst quickly disappeared.  We began with the antipasto which included
 carpaccio, prosciutto and melon, roasted peppers and anchovies - among many other
traditional Italian starters.  For the main course, I went with their veal parmigiana
- which was fabulous.  In fact, it was the best that I've had outside of Italy. 
 It was pounded to perfection and perfectly cooked.  And, the pasta?  Wonderful!
  What can I say.  The added feature was Tom Selleck sitting in the corner enjoying
his own plate of pasta.  Evidently, Matt Lauer of ABC News is also a frequent guest.
 Either way - if you want to enjoy great food or simply do some celebrity watching,
I'd recommend Elio's - 1621 2nd Ave, New York, NY 10028 - (212) 772-2242 - places.singleplatform.com
[http://r20.rs6.net/tn.jsp?f=001l2ngh4pJyhoO7MpMzat6sJc6Kg2qru78LUNnWKdfan3CtWtxTXfBWgx-l2vimrG6cgPalprM7BwJbNE9-zsjEWre5ZPF0AZWtw6EW3uxv5pc8YFcn1D48jsiIJIDi2XFr6pjfcJ2owno6TXpHuhvqUPeWE9vHay3sKBFviOyTVuLTYVl8eIUfOjKm_5m5XleN_rB4XYyX46GHWj_2ZJlPJ5yGvFATCG1zfgWl2qTI7I=&c=J2uBN1tg1XEXUjU0S5-3Z7vMEytFRA0DVxb2TwNO8Okkyx9BR91Zxg==&ch=3NY2JYomJ3qdJdJKH4__ajEAdU8RZKbu-mF2gSsuGgnz-xX62E6Uqg==]
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The Good, The Bad, And The Ugly
The ongoing saga...
The Great - The Christmas, Hanukkah and Kwanzaa holiday season is upon us where 
hopefully we can put the election season behind us and enjoy family and friends 
- without arguing, of course, about the future direction of the USA, let alone the
rest of the world J.
The Good - I think I know what to get this Christmas...
The Bad - The proposed "changes" in direction for health care will likely cause 
a stall or major delay in proceeding with needed experimentation with value-based
models of care delivery rather than traditional volume-based health care.  Again,
I state what I've stated many times: without a fundamental realignment of health
 care incentives, our industry will bankrupt the nation.  We need to keep change
 at the forefront rather than trying to push it out of the way...
The Ugly - The apparent rise of racism, sexism, secular disdain for religious faiths
like Muslims and a whole host of other "isms" that we should NOT tolerate.  We are
a nation built on the backs of immigrants - including my relatives and those of 
virtually every other American citizen except my Native American cousins.
The statements in The Fickenscher Files [http://r20.rs6.net/tn.jsp?f=001l2ngh4pJyhoO7MpMzat6sJc6Kg2qru78LUNnWKdfan3CtWtxTXfBWnklVk3Z4IRXt_lu-VqbBtTV0rQVkXSaFSKydv7RY7_KhZBp68NG4-yDvfwIsTYHpLLbq1ZvPMTa1d40GLMzdcCd0U5R8yOrMbXOsNRv4Sat_ZnCteV7ndt7SXyJ91LNbAcnTB4670t6&c=J2uBN1tg1XEXUjU0S5-3Z7vMEytFRA0DVxb2TwNO8Okkyx9BR91Zxg==&ch=3NY2JYomJ3qdJdJKH4__ajEAdU8RZKbu-mF2gSsuGgnz-xX62E6Uqg==]
are the personal views of
Kevin Fickenscher, MD and do not reflect the views or policies
of any organization with which he is affiliated.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

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The Fickenscher Files | PO Box 840 | Kittery | ME | 039