Subject: News from Dr. Kevin Fickenscher
From: "The Fickenscher Files" <[email-masked]>
To: <[email-masked]>
Date: Thu, 11 Oct 2018 17:13:01 -0400 (EDT)

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The Fickenscher Files [http://r20.rs6.net/tn.jsp?f=001mSfru7mlqJ-eMqw1mhvpdOmEkMiJxiURopooAliFS6Szvcqu90Czpv-XH0mD7tUw1mXHAijr6ju652j64zX-fFXjvf3MoxFyJA5dwrSLbUxhFfaJNXjUJfsvVl3vNdBtwN0GoYKaQTCXpJG7gF9l6tX7_a_h1_cG9tkKfKVUu1lhCFn4H4UPGREpfDiD9BKB&c=aYMaQcDWv_mqEtuyDbXuKRmdZAv3upYSWArIpdLWEMzAn-R6aBjJoA==&ch=0TLkhGokWTcWBi-IUxEuqDCkR4gWGWRzgdGJ9JjUzIMCajdJZ134YQ==]
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The Fickenscher Files, Vol. 6, Issue 13
Kevin M. Fickenscher [http://r20.rs6.net/tn.jsp?f=001mSfru7mlqJ-eMqw1mhvpdOmEkMiJxiURopooAliFS6Szvcqu90Czph7w70GWea4t6YX8Aq4KHVJc8Tc6FWfsIiZ_hAAPEOC7slDx1szHwle7NioWPVMAVKtszlC0ZLIo4f9LinjY-oqxl3ydFBWwFcR141KQm9YtnOHWpSzBT3QNicWTvAyFSdiz2AXU35jPKI4SJeWlFbIxicfL3tDL1A==&c=aYMaQcDWv_mqEtuyDbXuKRmdZAv3upYSWArIpdLWEMzAn-R6aBjJoA==&ch=0TLkhGokWTcWBi-IUxEuqDCkR4gWGWRzgdGJ9JjUzIMCajdJZ134YQ==],
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
"Democracy happens, with or without you."
Michelle Obama, First Lady of the Obama Administration - in her call to constituents
that they need to vote to make a difference...
"I think people should interpret the fact that I and others have made such a dramatic
shift from our prior position with respect to these products as representing the
 fact that we have seen information that is deeply disturbing and startling in terms
of the rapid rise of youth use over a short period of time."
Scott Gottleib, Food and Drug Administration Commissioner in his awakening on the
potential hazards of vaping when the FDA raided Juul, a $15 billion e-cigarette 
company to gain access to its data...
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Media To Consider
Books and Articles worth a Review...
The Coders of Kentucky - The New York Times recently posted an important article
 [http://r20.rs6.net/tn.jsp?f=001mSfru7mlqJ-eMqw1mhvpdOmEkMiJxiURopooAliFS6Szvcqu90CzpnLKwB5DsA5SYRtFhQFH8RaegKMjLbK6Kk7XIgwHCc2DIJoU_YnLbcSsP287uQErDMUnK_IDtwU-zQ8weJqjThYMEDKMgHgQ6-rBG_372UCOvYli5Hy-NpX0CS05dtKZYbeA08UilhUQRE_U5LDuxT10BAjAh0J8iq7BxJnTzNVlCakN54LovqysXLMeo5JiB7x_AZTUMvu6&c=aYMaQcDWv_mqEtuyDbXuKRmdZAv3upYSWArIpdLWEMzAn-R6aBjJoA==&ch=0TLkhGokWTcWBi-IUxEuqDCkR4gWGWRzgdGJ9JjUzIMCajdJZ134YQ==]
that all of us need to read in this time of revolution. First, a brief history lesson.
The First Industrial Revolution lasted about 120 years. It tore apart professions
that had been passed down from generation to generation. In fact, my great-grandfather
was a victim in the line of progress. He was a tanner in Bavaria who lost his job
to the looms. Like many of that generation experienced, there was disruption. The
options were few and far between in Germany at the time plus Otto Von Bismarck was
engaging in lots of little wars with his neighbors throughout Europe. My great-grandfather
thought better of fighting wars as an unemployed tanner so he picked up his family
and moved to America to become a farmer in Western Nebraska as a homesteader. There
were further revolutions along the way and now we are facing the digital revolution.
The difference is that instead of 120 years it will likely only take 20 years and
the disruption will be far more significant. It will affect not just coal miners
 and linemen in car factories. It will also "affect doctors, lawyers and such." 
But, rather than hide or blame immigrants (like my great-grandfather) or engage 
in other disruptions - we need to learn from the past. Education is the key. It 
is disingenuous to tell coal miners that they will all get their jobs back! Rather,
the US should do what the Times article points out - which is to retrain people 
with new skills, added knowledge and capabilities for meeting new challenges. From
the hills and hollers of Eastern Kentucky, a new breeding ground of cybercoders 
has been created that will no doubt change the landscape. The same type of thinking
needs to go into retraining and educating workers so they can hold jobs in new areas.
Just as farming, tanning, car manufacturing and a host of other well-paying professions
have radically changed - so it will be as the continuous cycle of change moves society
forward. Continuous education and re-education are the keys to success. I see it
 with doctors, lawyers and such - because they're next...
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Thoughts Beyond Health Care...
In an era of considerable name calling and ugliness - there are some very good things
happening...

Witnessing The Revolution: Building The Foundation Through #MeToo - The #MeToo movement
has been top of mind for most of us over the last month. In a world where every 
day brings a flurry of new news as the life of our national soap opera unfolds, 
the Kavanaugh hearings were perhaps a seminal turning point in our nation's dialogue.
The hearings brought to the forefront the #MeToo movement [http://r20.rs6.net/tn.jsp?f=001mSfru7mlqJ-eMqw1mhvpdOmEkMiJxiURopooAliFS6Szvcqu90CzpnLKwB5DsA5SaZuOJW_C0GRTRkgkGCWlbrt_LeVhR2KZIs8O6POJv91pyQjtQm56Ff13WtP5BWRYzcdPw8udsTdKkoQmoSJ53PQNCdllZf8Ha2Fch-vLBNew1L5gOxK37_NFfBvUn-BG8XKmnc57M6CJl8h-Z6IEYEYpttYqBq-TlpnXFRpvrKsBsfFo0GB-ZuLvEa8UbBYFGYhVRGEAKAouN3RU_44b-A==&c=aYMaQcDWv_mqEtuyDbXuKRmdZAv3upYSWArIpdLWEMzAn-R6aBjJoA==&ch=0TLkhGokWTcWBi-IUxEuqDCkR4gWGWRzgdGJ9JjUzIMCajdJZ134YQ==].
Witness the sign we saw in the window of a shop as we strolled to dinner the day
 of the Kavanaugh vote in the US Senate. It speaks about all women and the role 
of all people and all families. I suspect that Tarana Burke - the Founder of #MeToo
in 2006 - never anticipated that the community initiative she created for connecting
survivors of sexual violence would have such national and international ramifications.
Although I can point to incredible gains that have been made for women over the 
course of my lifetime - we have a long way to go...and, I'll leave it at that! So,
while the issue of sexual violence, let alone sexual disrespect, is an extremely
 important one for society to address, I believe the movement is extending beyond
the too frequently disempowered, one-half of our nation's and world's population
 - women! In fact, when we look back in a couple of decades, my prediction is that
the #MeToo movement will be as much about bringing into the fold the diversity of
the whole human populace rather than just half of it - or, at least that is my prediction
for the United States. We are seeing the last hurrah of domination by old white 
men (I am one of them by happenstance of birth) in America. Women ANDpeople of other
cultures, perspectives, preferences and colors are coming to the forefront of society
- AND, THAT IS A VERY, VERY GOOD OUTCOME!!The #MeToo movement is highlighting the
acceptance of diversity across the nation. It's about time. It's about women but,
it's more than just about women. In fact, I believe the #MeToo movement is the cornerstone
of the diversity movement which is finally coming to America. We've been struggling
with it since the Civil War. I suspect we will continue to struggle with it in the
years ahead. But, hopefully, the new generations will take the lead and move acceptance
to a higher plane - a calling, if you will - for what the United States of American
stands for... To all women - thank you for changing our society for the better. 
Yes, we've come a long way but we have so much further to go! The Kavanaugh hearings
have helped the nation extend a dialogue that is only just now beginning to reshape
society. Don't be disheartened. The picture in the window caught the spirit of the
changes we are experiencing. We all need to continue the quest for making the spirit
a reality for women and everyone.
Crossing The Boundaries - To my point above, I recently read a news story [http://r20.rs6.net/tn.jsp?f=001mSfru7mlqJ-eMqw1mhvpdOmEkMiJxiURopooAliFS6Szvcqu90CzpnLKwB5DsA5SMWzSKIhDuJrGcslRI9m0BM8c107oxcPVFC09sEHkL0BDnb_JGMrEmRi00rrnZXZSWwIkbZl5xbbppOgauqoQGjfsB44N3i4_DzXfTpR6mCfFR6zDb8OejB1zZ-2JIzw9vvJ8VJudwUY=&c=aYMaQcDWv_mqEtuyDbXuKRmdZAv3upYSWArIpdLWEMzAn-R6aBjJoA==&ch=0TLkhGokWTcWBi-IUxEuqDCkR4gWGWRzgdGJ9JjUzIMCajdJZ134YQ==]
about a young women who won the homecoming queen vote at her school and saved the
day for her school's football team - all on the same night. She's a student at Ocean
Springs MS High School in Florida. Senior Kaylee Foster had the double honor of 
being named homecoming queen and serving up the winning points as the kicker for
 the football team. The younger generation are crossing all sorts of boundaries.
 I look forward to their leadership as they take the reins of society and guide 
us into the new millennia. In a similar vein, our youngest was arrested for demonstrating
while in Washington, DC. When Senator Susan Collins gave her speech (apologia) on
the US Senate floor last week, there was an outburst in the gallery. The outburst
was a statement of angst about all of the events over the preceding weeks. But, 
even though the protest did not stop the speech, the arrest awakened within her 
the desire to "make a difference" just as the protests of the 60s did the same for
my generation. The flame of change to make a difference [http://r20.rs6.net/tn.jsp?f=001mSfru7mlqJ-eMqw1mhvpdOmEkMiJxiURopooAliFS6Szvcqu90CzpnLKwB5DsA5SYmXV1BhI1Bh1pQqzw54QnYT6rTNDZGipg_GAk8kkxX8Xu0xucReLJ0ZrY8Uhl7ymD277obAvltYj08_wKx0TTw2r8FNSQFQCvEjCL_gqSZTlLsWMXY2BqVBkhMnz-OoMWdhvcTSsohk=&c=aYMaQcDWv_mqEtuyDbXuKRmdZAv3upYSWArIpdLWEMzAn-R6aBjJoA==&ch=0TLkhGokWTcWBi-IUxEuqDCkR4gWGWRzgdGJ9JjUzIMCajdJZ134YQ==]
is bright and alive. It will change society. Let's also hope and pray that some 
of that energy, that desire, that focus for change will be invested in making health
care better!
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Consulo Indicium
Information for your Consideration...
Combatting the Opioid Menace - The US Department of Health and Human Services (DHHS)
recently announced that the agency has "awarded more than $1 billion in grants to
states, communities and organizations fighting the opioid crisis." The bulk of the
money ($930 million) has been allocated to support state efforts related to providing
treatment and prevention services in combating the opioid problem.  DHHS also has
allocated more than $350 million to community health centers throughout the nation
to increase access for substance use disorder and mental health services.  The efforts
are to be applauded but, we need to go beyond ex post facto treatment.  Prevention
is the key and a broad strategy for engaging in prevention has yet to be put forward
in an effective way.  So, let's give the Administration credit for what's been done
but push them to do more.  The opioid problem cuts across all societal sectors. 
 More effort needs to be put into solving the problem...
Health Care Leaders Group Speak Out on Top Concerns - The HealthCare Executive Group
(HCEG) recently released its Top 10 list of concerns [http://r20.rs6.net/tn.jsp?f=001mSfru7mlqJ-eMqw1mhvpdOmEkMiJxiURopooAliFS6Szvcqu90CzpnLKwB5DsA5SyU7_dPfQtmDi_TOtOjVmNATpCh6eCbM3jXyjqquevoCjCy1mwvFW5XkOXKwSB9Rq05-y1L8OzvaF5rw1RKrOBYAkebE0nqExFfCXWl97MVTwcwgcSOL5zmrdK4_9Rppr38lJKEfb1elvd_xVQsMCg3oMSsncmnQSISTYT_1dxP6xLg2Mj-vsNxvianYld6tj3fY8FBCZK_jEeviAKPzxAKH1rfkt2F9d_jbO8klckOUjImswOH4LUHdv9pnVxlUF796mOFkPfeY89uE84aIGLoVnp5oHxVFbbM6JdEUXTKxDa8Hu1IbN9EV_EvbpLxYapHonPggJW1BYBFpR4hiuMxbC5BUIhJR5MWRd9hmma2FMCVoudjQIRvkeFblgUodDOvq0fKTHFCX08Pr2Gspa257T17SpkjaexQLiQPzdnSJGNjC3vzu1Ls3PYJ1pKcwjS_RhExzfkvM=&c=aYMaQcDWv_mqEtuyDbXuKRmdZAv3upYSWArIpdLWEMzAn-R6aBjJoA==&ch=0TLkhGokWTcWBi-IUxEuqDCkR4gWGWRzgdGJ9JjUzIMCajdJZ134YQ==].
The group consists of provider, payor, technology and other related industry leaders
who engage in a multiple day discussion before determining their consensus list 
of issues. The results of their list which presents challenges, issues and opportunities
were as follows:

1. Data &      Analytics: Rising to the top of the list,      the issue was all 
about leveraging the data - especially the clinical data      - to manage health
 care more effectively and to support decision-making.
2. Total Consumer      Health: The consensus was focused on improving      the overall
medical, social, financial, and environmental well-being of      individuals seeking
health care services.
3. Population      Health Services: There has been lots of talk about population
 health but not as much      action. The discussions centered on      operationalizing
community-based health strategies      that support chronic care management, drive
clinical integration, and      address barriers by integrating the social determinants
of health as      action points.
4. Value-based      Payments: Again, another area that has gotten lots of talk and
less      action. The need for systems to      support the targeting of specific
 medical      conditions to improve quality of care and manage costs rose to the
 top of      the discussion points.
5. The Digital      Healthcare Organization: Health care      is becoming a digital
enterprise so literally all elements of the health      care network including: 
portals, patient literacy, cost transparency,      digital payments, mobile wearables
and devices, other patient-generated      data, remote monitoring, and omni-channel
access/distribution of data were      all issues that percolated to the top of the
agenda.
6. Rising      Pharmacy Costs: Strategies      to address the continuing escalation
of pharma costs along with the best      approaches for measuring benefits to quality
of care and total healthcare      costs were highlighted
7. External      Market Disruption: Suffice it      to say, there was lots of discussion
about the plethora of announcements      emanating from new players in health care
like Amazon, Chase, Apple,      Walmart, Google - and, others...
8. Operational      Effectiveness: The      spectrum of opportunities for creating
efficiencies was discussed      including: implementing lean quality programs, process
efficiency (with      new core business models), robotics automation, revenue cycle
management, and      real-/near-time point of sales transactions.
9. Opioid      Management: The struggle continues despite investments      at the
state and federal level for developing strategies to identify and      support individuals
and populations who struggle with substance      abuse/addiction or are at-risk 
of addiction.
10.  Cybersecurity: Finally,      for the fourth year in a row, cybersecurity was
listed in the Top 10      list. The protection of data by      maintaining the privacy
and security of consumer information and trust in      sharing data were top concerns.
The Source of Academic Leadership - For the last century at least and probably longer,
the USA has been a leader in academic circles. Our research, our universities, our
academicians have been the points of discovery for this little wonder we call, Earth.
It's been the Golden Age in America. But, we are seeing the glimmer of change on
 the horizon and, the challenge is coming from the East. I remember my first visit
to China in 1978 as a member of one of the very first delegations of health care
 professionals to visit China since before the Revolution. We were impressed with
the many public health measures that had been implemented to improve the health 
of the people. It was remarkable! But, it was also obvious that China was well behind
the USA in research, acute care and much of the rest of health care. Now, 40 years
later (yes, 40 - argh), China is coming of age [http://r20.rs6.net/tn.jsp?f=001mSfru7mlqJ-eMqw1mhvpdOmEkMiJxiURopooAliFS6Szvcqu90CzpnLKwB5DsA5SYtmqXI0XbH5fWrpZGuoErag2cc110gAXDCBY-n72Q4tqJdHsTkWdvxbrLG8DdSp1_DbSSDDMxIhSpefgZvSoWdb1CHUBZLAew4FFUB4okKOT2k0etwlhqIqwsHL7jonIlMmxyAyprvfMJcP4k8W78z1gZ7jAZe_kZUMjsDIXbHvLceVcQDHMe8WjB9Fy6xcn4tPzQWMUuV0MTudaHZR525Tqw65ZA9ZfdKT9vle31p8=&c=aYMaQcDWv_mqEtuyDbXuKRmdZAv3upYSWArIpdLWEMzAn-R6aBjJoA==&ch=0TLkhGokWTcWBi-IUxEuqDCkR4gWGWRzgdGJ9JjUzIMCajdJZ134YQ==]
as a leader in the scholarly community. In recent years, the Chinese government 
has shifted its focus from investments that improve agriculture and manufacturing
toward more scientific efforts. Witness the growth of investment in the technology
sector as well as the fact that 11 of the top 100 universities globally are Chinese.
During the ensuing period, Chinese academics [http://r20.rs6.net/tn.jsp?f=001mSfru7mlqJ-eMqw1mhvpdOmEkMiJxiURopooAliFS6Szvcqu90CzpnLKwB5DsA5Ss_IWVy4D-ltdk4zvGlysWL0Y1s4rGWOmGEwHH9U1gKJsOVhgf5M083mfesyL9rYvfzDK03g9686JfcgQy0v813bCnqAK4fiyviEDUUn9W4JeF0uobkgxRK-1P22ynEBF&c=aYMaQcDWv_mqEtuyDbXuKRmdZAv3upYSWArIpdLWEMzAn-R6aBjJoA==&ch=0TLkhGokWTcWBi-IUxEuqDCkR4gWGWRzgdGJ9JjUzIMCajdJZ134YQ==]
have also moved to the pole position in the academic publications for math, the 
physical sciences and engineering where the number of academic publications has 
quadrupled since 2000. For example, in Nature and Science, 20% of the publications
emanate from Chinese authors based at Chinese universities. Research in health care
is not far behind. While the quality of their output is not up to par with the US,
it's not far behind either...
So, what's the US response? Rather than embracing the change, the US government 
under the Trump Administration has started tightening [http://r20.rs6.net/tn.jsp?f=001mSfru7mlqJ-eMqw1mhvpdOmEkMiJxiURopooAliFS6Szvcqu90CzpnLKwB5DsA5Sw4oY96LFhflcTvTRSXsMAxYm43-zDUQwQZjrKqMydBvQWSKcv0pdMmniclwdhpQRmxgKioRIp3Dscu59I7e-hBUerJ0OZ0-1onqA0kFumhGGW-o0o5Znm_Xk534WlProGfCHHwjXjZz5XjrAiuyw_cNllnn_8f70yv2f9aGi69w2vTpcY76uF2ph788hNKYvE-Dtlqknnxm5Wswicrams-h_YsN60IwczK9_KJVGcx8=&c=aYMaQcDWv_mqEtuyDbXuKRmdZAv3upYSWArIpdLWEMzAn-R6aBjJoA==&ch=0TLkhGokWTcWBi-IUxEuqDCkR4gWGWRzgdGJ9JjUzIMCajdJZ134YQ==]
the rules for obtaining study or work [http://r20.rs6.net/tn.jsp?f=001mSfru7mlqJ-eMqw1mhvpdOmEkMiJxiURopooAliFS6Szvcqu90CzpnLKwB5DsA5SGKah044u9Ksnvxx0ShLGyhEUUAEY8r0kyxcCZLtoGpV6_0_nIKqbTJ7CdbfozZo3Aq2ZDeKYpYyGKlnmPSao9GMC2NH7scvjAeuNUEyn1NApATkPcwYjr0Chu9vD7ipUdoAqLloy2dyRHujO4LSt44GQdJLW7t5jjM_Pm6LUCB8Fb7qpnMpPJBYcJHPS8VmuDyGxagp7jwA=&c=aYMaQcDWv_mqEtuyDbXuKRmdZAv3upYSWArIpdLWEMzAn-R6aBjJoA==&ch=0TLkhGokWTcWBi-IUxEuqDCkR4gWGWRzgdGJ9JjUzIMCajdJZ134YQ==]
visas for Chinese academics - which now represent 1/3 of foreign students studying
in America. The clamp down is being done on the notion that these academicians are
gaining too much information and knowledge by studying in the US. However, our US
scientific community has reacted with alarm [http://r20.rs6.net/tn.jsp?f=001mSfru7mlqJ-eMqw1mhvpdOmEkMiJxiURopooAliFS6Szvcqu90CzpnLKwB5DsA5SKYFnbaWJnVMYRoS9twy6mU-5zAA0JWvhBP9r0Xvp4cDUb3GjbbyaoZb4NXmUUfuTL7jZfG5POus9E-irXhbAHx4ZtANBlgC9qW2Km6Nv0f5889HEyd8FGpCK9zqgjOTIjb8uzyIThUb1EYaE3_8SEI6VBFyju4uTDb7Kj2AMcIUL9O3Z-Bwo5fucu7j0GMyWxAKvI6KUvZGq_W0ZmRs6PwzihALxjrgkX5eLWtq4ApU=&c=aYMaQcDWv_mqEtuyDbXuKRmdZAv3upYSWArIpdLWEMzAn-R6aBjJoA==&ch=0TLkhGokWTcWBi-IUxEuqDCkR4gWGWRzgdGJ9JjUzIMCajdJZ134YQ==].
Knowledge is porous. The good part about the Chinese studying in the US is that 
they get to know our culture, the way we live, the way we think and - while there
are many good elements about Chinese culture - they learn the US is not some evil
empire. Scientific process absolutely requires an open collaboration. If, in fact,
there are documented episodes of espionage or unsuitable behavior we have other 
avenues for managing such situations like criminal prosecution or academic expulsion.
But, simply building a wall against academic collaboration will result in exactly
the wrong result - the slow decline of research leadership in America. Rather than
closing our doors, we should open them wide and serve as the source of collaboration
and collegial exchange. At the end of the day, such an approach will yield far greater
results than hiding behind our borders.
Paying It Forward - Yet another survey is out noting that workers are shouldering
an ever-growing share of their medical costs because employers are simply passing
along the additional health insurance costs in the form of deductibles. The non-profit
Kaiser Family Foundation conducted a survey [http://r20.rs6.net/tn.jsp?f=001mSfru7mlqJ-eMqw1mhvpdOmEkMiJxiURopooAliFS6Szvcqu90CzpnLKwB5DsA5SUU2UGXFFVUXBQtAb4O0wNL2Kv0-MNedFKEACMDXyFCUe1GYr8TTs9xMxv1jWH14judQG78A3IINGoeR5Liob9AF5ZRwOn3_iae7eaCIAiIU=&c=aYMaQcDWv_mqEtuyDbXuKRmdZAv3upYSWArIpdLWEMzAn-R6aBjJoA==&ch=0TLkhGokWTcWBi-IUxEuqDCkR4gWGWRzgdGJ9JjUzIMCajdJZ134YQ==]
showing that health insurance premiums and deductibles for American workers continued
to escalate in 2018. But, it wasn't just the escalation, it was also the fact that
cost increases are outpacing wage growth and inflation. For example, the average
 cost of a family health plan is now $19,616 a year, with workers contributing $5,547,
or about a quarter of the cost. Employers pick up the balance of health plan costs
for the workers as a benefit. But, the number of workers with large deductibles 
is increasing. In 2009, only 7% of workers had a deductible of $2000 for single 
coverage. Today, it is 26% (See Table).
What we've seen in the market place is that

health insurance premium increases have moderated, increasing by about 5%. However,
deductibles have marched forward as employers adopt strategies which shift the cost
burden to the workers. With the Republican efforts in play to undo the Accountable
Care Act (ACA), access to affordable insurance has become increasingly problematic.
I've said this before BUT - rather than undoing, we need to amend the ACA. After
 all, even though neither political party seems to believe it, solutions do come
 to the middle. They are not at the extremes of political agendas. Perhaps the focus
should shift toward doing something right for the American people as a whole. The
next revolution that we will see in the streets are marches about access to health
care. Mark my word - they are coming. In 2000, 68% of the employers offered health
insurance. That dropped to just over one-half by 2017 although it has increased 
to 57% for 2018. This is the one issue I get more emails on than any other - except,
of course, those related to restaurants and where to eat...
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Future Health
Delivering care in the new virtual world...
From Bullets to Bytes - There's a new kind of warfare being used at the forefront
of international conflicts that has troubling implications. According to a new report
by CB Insights [http://r20.rs6.net/tn.jsp?f=001mSfru7mlqJ-eMqw1mhvpdOmEkMiJxiURopooAliFS6Szvcqu90CzpnLKwB5DsA5SxceUVMNLEmvAInB2zGbDcNiTPTFHXMVlwulxg-MxpF1h_c1yiEIJXZHj8vDBSmbpmf_a_gY5zbGSxbMxAonkiZPlQ1uRISGa-pamUkNSUxjRt79w6yCDYMCcMxQKe0EzJFivzzk8Ra5P0jXQ8LanlgbmI4z9Fd9dlYJRHPICQP5JctmPI-zb1mcf8yNozhEZz5iadtxAJMQx9EK4nf_Ig2eFcBEJ6Z0Bm10MpuPsYXMpR26ezg8s2LbcAdfsZ0JNjQ44Q9m452_MwXIMQJFq4YRJM8hvWfLGAYKhK7SV8CGnUDaBeFqBJZ_xjEYEabkGXeXQgXvwwW3XPVw0v3xvId04p7wDP3webP1T5UnlixWDpKY6c_bratJvvqGm4JlYbsd2rIknzyLGbo8knRhDocxyZeMBJ044BgdY_B0X_xv6cHWQofBqzUCiBKrZ8_gSEP63JFfHIc3f-MIRZYDtx-PhFhb9SPqg7pwnRNnePqb6Y9DP6ksbnGNB1cENYjKm5_nKyVU5orVJI1t8QtnU5iNVE2GZ--rnjmrMUYVT3vTYLp3u7FbsyDlrsEY683curvoV0aNPjwdL6IHzyKFVqFmqcfniG7eNXCnjXD1-uL4cqrG2r8gDlXZ3gV49P9D1KoNyZTAnFKvCrNWbsA-SnA==&c=aYMaQcDWv_mqEtuyDbXuKRmdZAv3upYSWArIpdLWEMzAn-R6aBjJoA==&ch=0TLkhGokWTcWBi-IUxEuqDCkR4gWGWRzgdGJ9JjUzIMCajdJZ134YQ==]
the exploitation of data is on a very troubling increase. Here are some data points
to consider:

* 3 billion - the number of compromised accounts in the Yahoo breach where thieves
were able to obtain names, email addresses, phone numbers and other data
* 200 million - the number of registered US voters whose personal information was
accidentally exposed online,
* 146 million - the Equifax breach affected this number of folks and it contained
SSA numbers, birth dates, addresses and the like affecting about 50% of the USA 
population,
* 57 million - data stolen from Uber customers where the thieves extorted $100,000
from the company, and,
* On and on and on...
But as troubling at these points are, the even more challenging piece is the use
 of inaccurate data and information to sway people. And, it's not just emails that
are being sent. It's pictures that have been photoshopped, it's queries from people
that are simply fishing, it's a whole range of strategies designed to upset the 
apple cart of opinion, perspective and thoughts. In particular, these attacks are
using "bytes" instead of "bullets" to engage in a type of warfare that we've never
experienced before. I'm not panicking. But, I am forewarning. As a country, we need
to be investing much more aggressively in developing capabilities to counteract 
these byte-size warfare patterns. Health care - in particular - is an industry that
is ripe for invasion. We need to be on the alert to a much higher degree than currently
exists within our community. While some attention is being given to cybersecurity
and the needs within the health care community - we could be doing better. The problem
with "bytes" is that they can hurt just as much as "bullets" and even more so in
 some cases. Stay tuned.
Kaiser Reports on Video Visits - Just today as I was writing my blog, a report came
out from Kaiser in the New England Journal of Medicine on the use of telemedicine
by Kaiser physicians [http://r20.rs6.net/tn.jsp?f=001mSfru7mlqJ-eMqw1mhvpdOmEkMiJxiURopooAliFS6Szvcqu90CzpnLKwB5DsA5SJkGdplzVZNQxUYDzmQ4_eMorze8nUgxX1eWQlVw2QLZ00gZCvQSzRBoy50Dk3xwGakpz5uVi0eWN7ziEFULUCTof0r80vvLfS6LWi_9ePdREdCIboJ4gekDOmGDi0CFFwVOKpF4kR9QiffaHQQ1mrg8kW02C7yVPpi8CkUu4DBe4uFemqEF8rvuqkaXm7_ZO&c=aYMaQcDWv_mqEtuyDbXuKRmdZAv3upYSWArIpdLWEMzAn-R6aBjJoA==&ch=0TLkhGokWTcWBi-IUxEuqDCkR4gWGWRzgdGJ9JjUzIMCajdJZ134YQ==].
Since 2015 when the program was implemented, there have been over 200,000 scheduled
video visits for a variety of problems. The bulk of the visits were for issues related
to medicine, pediatrics, dermatology, after-hours care and psychiatry. Importantly,
over 90% of the patients who access telemedicine services had accessed in-person
 health care services in the prior year. Finally, among the visits - 70% were completed
with the patient's own primary care provider. Now this is an integrated approach.
It's what's missing from much of the health care community.
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The Weekly Whisk
Musings from a foodie...
I know I've become an unabashed Mainer! It's because Maine is just like my home 
state of North Dakota - except it has ocean, mountains and trees. Other than that
- it's just like home. But, my other home that I've come to love is Greece. We visit
there every year (it's a long story...) and I've come to treasure the long, leisurely
Greek dinners with friends and adopted family. So, it was with some degree of surprise
that we discovered Taverna Khione [http://r20.rs6.net/tn.jsp?f=001mSfru7mlqJ-eMqw1mhvpdOmEkMiJxiURopooAliFS6Szvcqu90CzpnLKwB5DsA5SuGVHblQMBTPv6FhkJoRMzYRitQhExSKtcrmYRBwjbLjalF23lfyGM8mqRyL539kvl9oM4BLiU1T_iiuBeNyrFvOL8XmIptiDlVSIxabQ_5_vNQ7BI6KJWQ==&c=aYMaQcDWv_mqEtuyDbXuKRmdZAv3upYSWArIpdLWEMzAn-R6aBjJoA==&ch=0TLkhGokWTcWBi-IUxEuqDCkR4gWGWRzgdGJ9JjUzIMCajdJZ134YQ==]
[* * * * *] near Portland, Maine in Brunswick. The chef, Marc Provencher, is a Greekophilic
cook whose been a part of several restaurants in the area over the last number of
years. The restaurant is off the beaten path on a side street and presents a cozy
atmosphere with a casual style and open kitchen. From the start with his grandmother-inspired
bread and the traditional spreads the presentation of regional Greek classics, his
menus fosters an enthusiastic desire to try everything. But, you can't - so, it 
means you have to come back, again and again. Check out the taverna if you get close
to Portland, Maine (about 1 hour 15 minutes from Logan airport). Taverna Khione 
- 25 Mill Street - Brunswick , Maine , 04011 -  (207) 406-2847 -www.tavernakhione.com
[http://r20.rs6.net/tn.jsp?f=001mSfru7mlqJ-eMqw1mhvpdOmEkMiJxiURopooAliFS6Szvcqu90CzpnLKwB5DsA5SuGVHblQMBTPv6FhkJoRMzYRitQhExSKtcrmYRBwjbLjalF23lfyGM8mqRyL539kvl9oM4BLiU1T_iiuBeNyrFvOL8XmIptiDlVSIxabQ_5_vNQ7BI6KJWQ==&c=aYMaQcDWv_mqEtuyDbXuKRmdZAv3upYSWArIpdLWEMzAn-R6aBjJoA==&ch=0TLkhGokWTcWBi-IUxEuqDCkR4gWGWRzgdGJ9JjUzIMCajdJZ134YQ==].
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The Good, The Bad, And The Ugly
The ongoing saga...
The Great - The mid-term elections are now only 26 days away. Then, a couple of 
days of reprieve before we head into the next election cycle &#x2639;.
The Good - Hmmm...if you have thoughts - send them!
The Bad - There is so much "bad" going on that it's difficult to come up with a 
singular "bad" issue. However, the 13,000 children who came to the United States
 on their own and which are held in federally contracted shelters is the worst of
the worse. There are now five times more children in immigrant shelters than in 
2017.
The Ugly - The entire Kavanaugh hearing saga is replete with ugly issues on both
 sides of the aisle.
The statements in The Fickenscher Files [http://r20.rs6.net/tn.jsp?f=001mSfru7mlqJ-eMqw1mhvpdOmEkMiJxiURopooAliFS6Szvcqu90Czpv-XH0mD7tUw1mXHAijr6ju652j64zX-fFXjvf3MoxFyJA5dwrSLbUxhFfaJNXjUJfsvVl3vNdBtwN0GoYKaQTCXpJG7gF9l6tX7_a_h1_cG9tkKfKVUu1lhCFn4H4UPGREpfDiD9BKB&c=aYMaQcDWv_mqEtuyDbXuKRmdZAv3upYSWArIpdLWEMzAn-R6aBjJoA==&ch=0TLkhGokWTcWBi-IUxEuqDCkR4gWGWRzgdGJ9JjUzIMCajdJZ134YQ==]
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