Bicyclist Fatalities in AZ 2009

On 12/1/2010 11:36 AM, Clive George wrote:
On 01/12/2010 13:37, Peter Cole wrote:

My experience as a patient doesn't agree with that claim. I'm sure there
are plenty of bad systems in use, and I'm also sure that many users
aren't particularly adept and struggle accordingly. All that doesn't
invalidate the concept. Computer systems have been driving productivity
for decades now, and are used virtually universally, mostly where such
use isn't mandatory, and where productivity is monitored by people with
very sharp pencils (so to speak).

I'm not convinced by that - I write and use such systems for a living,
and the productivity changes don't seem to be that well monitored at
all. Those sharp pencils seem to be very blunt in many cases.

It's pretty straight forward, productivity just reduces labor costs,
which are generally closely watched. Of course the inevitable automation
of tasks means fewer people are needed, and staffs universally tend to
sabotage that outcome, in my experience, consciously or not. Any system
I delivered that didn't reduce head counts would have been judged a
failure. That never made me any friends.

On 12/1/2010 12:23 PM, (PeteCresswell) wrote:
Per Simon Lewis:
And for each of these there are 1000x examples where people have their
systems running well. Cross referencing, at a press record retrieval,
readable, cross referenced, easy to print/email etc.

There will always be incompetents.

This guy's complaint seemed to center around the time needed to
marshall and review historical data.

With the PC, he needs to enter a patient identifier, wait for the
application to return that patient, and then drill down through
multiple windows. This takes time/concentration and only a
fraction of the results can be viewed at one time. It also takes
several minutes just to get the relevant data.

He needs better filters.


With paper, he tells an assistant to assemble the histories -
then he flips open each folder and spreads/eyeballs the paper in
a matter of seconds.

Yes, but now he doesn't need the assistant.


Having limited gray matter myself - and having to deal with
relatively large (at least to me...) amounts of information - I
suspect that one thing he could do to mitigate that problem would
be installing multiple large displays - as in three or four
1920x1200 native-rez displays.

He would still have the task of drilling down thorough multiple
windows - as opposed to having somebody at a much lower hourly
rate put together the paper - but I think it would help just by
showing more information all at once.

Beyond that, I can see somebody who knows the software writing
macros that accept a patient ID or something and do the drilling
down automagically.

The optimal solution would seem tb integrated applications that
serve the user better than they do now - incorporating a global
search as via macros above.

I guess this means that Steve Jobs' job is safe, but I cannot
imagine anything that could equal the ease and speed of the
physician's just spreading and eyeballing the paper - except for
having the aforementioned hourly employee print out the relevant
material and put it in a folder as before.

My experience is that, although many processes work better using
a PC, others work better using paper.

Very few, in my experience. Software driven work is just different --
different set of skills or just a different approach. Of course there
are many wretched systems in place, many of which share your complaints
of too much navigation and too much extraneous information. Often that's
a direct result of the one-size-fits-all application suites. The irony
of IT is that custom development fell off just as the tools to do it
improved dramatically. Part of that is monopolistic practices (Oracle,
SAP, etc., etc.). The IT industry is pretty conservative and backward.

On 12/1/2010 2:09 PM, Radey Shouman wrote:

That's not even the worst of it. The poor shlemiel that consults a
doctor without benefit of insurance has established a pre-existing
condition, so even if he manages to buy insurance later he will have to
pay cash rates to treat whatever condition might have been discovered.

This might make sense in the context of actual insurance, but medical
insurance in the US is more about price fixing, so it feels more like a
protection racket. This is a real disincentive to seeking early medical
care.

Obamacare is supposed to fix this, eventually, but I'm not holding my
breath.

When HMO's first showed up, the hope was that they would "keep costs in
line", it turned out that they just found it much easier to pass them
along (after taking their cut, of course).

Tim McNamara writes:
I have to deal with a half dozen EMR systems in my consulting practice.
They range from bad to execrable. A pen and a piece of paper- or a
typewriter- remains faster, simpler, easier and more reliable than any
computer system. I spend twice as much time on documentation now as I
did 10 years ago, with the advent of computerization. To my observation
in my practice, EMRs do not make documentation more accurate or easier
to find.

Simon Lewis wrote:
Ludicrous. Then your systems are poorly chosen and/or you didnt learn
how to use them.


You may be unfamiliar with this area. The goal of most
business computer systems is an enhancement to the
organization's overall quality or efficiency or both.
Medical electronic records are unencumbered by those goals.

--
Andrew Muzi
www.yellowjersey.org/
Open every day since 1 April, 1971

In article ,
Tºm Shermªn� °_° " wrote:

On 11/30/2010 9:13 AM, Tim McNamara wrote:
In ,
Tºm Shermªn? " wrote:

On 11/29/2010 10:46 AM, A. Muzi wrote:
[...] 30,000 people? I don't know, but walking into an ER and
walking out with a band-aid on one's knee and a $1200 bill four
hours later could be called 'serious' by some.


The bandage is probably itemized on the bill for $200.

LOL.

I recently had to have a plumber out to the house. The bill was
$395 or thereabouts for 45 minutes. Parts were about $5. So the
labor charge was north of $400 an hour. Clearly we need plumbing
reform in America.

Oh, wait. Profitable plumbers are a good thing. Why isn't
profitable health care a good thing? ;-) It's a funny thing. If
I make a profit from selling something to you, I'm running a
successful business. If you make a profit selling something to me,
you're ripping me off.

From the patient perspective in health care, there are a lot of
hidden costs paid by the provider. One of them is time. For every
hour of billable services, there is another hour of unbillable time
in documentation, records handling and storage, costs of preparing
and submitting bills, etc. (this is the case for psychologists, I
don't know about ER docs). If I work 40 clock hours a week, I can
do 25-30 billable hours with 10-15 clock hours going to
documentation; the business office and medical records office also
have time into each charge.

And, as a psychologist, I have a cheap practice to operate since
the only tools I really need are my knowledge and a way to do the
documentation. I don't have to have millions of dollars worth of
facilities, unlike a full-serivce medical clinic; a hospital has
hundreds of millions of dollars in equipment and physical plant
costs. Even a dentist has hundreds of thousands of dollars in
equipment costs. This is part of why health care costs as much as
it does; rapacious drug pricing is most of the rest of the reason.


What is needed are consumer owned purchasing cooperatives (large
enough that providers could not afford to ignore them) that would
accept unit rate bids for medical services, letting the market bring
fees for services in line. It works in commodity retail and many
services, so why not medical care?

One of the local HMOs, HealthPartners, is a cooperative. It is also a
non-profit, which is required of all HMOs in Minnesota (and, ironically,
keeps United Health from selling most of their policies here even though
Minnesota is where their corporate headquarters are). I think that
cooperatives are a great business model.

There is a trend in health care for doctors to modify or even go outside
of health insurance altogether, charging a monthly access fee like a
retainer which guarantees doctor access. It's called "concierge" or
"boutique" medicine. You can search the web to read up on the pros and
cons.

Why can I get a written quote before my truck is repaired, but not
before a medical procedure is performed?

You can; you have to ask because it's not normally done, except IME by
dentists and veterinarians. The problem for the provider is several
fold:

First, we often have no idea what the insurance company will pay for any
given service. Most providers are focused on the service rather than
the reimbursement. What is charged on the bill has almost nothing to do
with what the doctor actually gets paid in the vast majority of cases.

Second, the unforeseen crops up with regularity in health care because
people are astonishingly complex organisms; and people are often
untruthful and/or unaware with their providers about risk factors.
Fixing people is more complex than fixing cars or installing appliances.

Third, patients lie. A lot. They lie about their symptoms and they lie
about their compliance with treatment. This greatly complicates health
care and the costs thereof. If you're hiding something from the doc,
his or her estimate is going to be worthless. Docs don't want to be in
that situation.

There are cash-only clinics that do not accept insurance and provide a
menu of costs (e.g., throat culture $36, stitches $9 each, etc.). These
usually provide a limited range of services, since "liver transplant,
$200,000" is beyond most people's budgets.

http://www.azcentral.com/arizonarepu...0/11/17/201011
17ahcccs-budget-cuts-phoenix-man-liver-transplant.html

There are reasons that prices are astonishing. I have a friend who
volunteers as a courier for bone marrow transplants. He routinely flies
all over the world to pick up and deliver bone marrow, e.g., to Los
Angeles to get the bone marrow and then to Rome to deliver it to the
hospital. If he doesn't get it there in time, the patient dies (once
the patient is prepped for the transplant, they will die if they don't
get it). The costs of that transportation end up being part of the cost
of the transplant procedure ($150,000 to $250,000).

In modern health care we routinely do amazing, life-saving procedures.
Because we can, we tend to want to do it. But 51 million Americans
don't have access to that nor even to basic affordable health care
because we rate political ideology and insurance company profits above
human lives.

--
Gotta make it somehow on the dreams you still believe.

On Dec 1, 2:53*am, Radey Shouman wrote:

How goofy is it to think that one should have to pay premiums to a
plumbing insurance company or be sent to the poorhouse by unforeseen
plumbing? *Medical "insurance" companies long ago realized that actually
insuring people against medical risk was a mug's game, so they moved
into price fixing and being middlemen for almost all medical costs, but
not without assistance from government and the medical professions.

I can't imagine that such a scheme for plumbing would be legal, or if it
were that it would stay legal.

I'm seeing what may be moves in that direction.

The private company that supplies water to our village now sends out
periodic mailing: "Do you know the unprotected water line to your
home is your responsibility?" and it talks about the possibility of
huge repair bills should that line suddenly fail. But you can buy
"peace of mind" by opting for their line insurance.

The phone company offers similar "peace of mind" for the telephone
wiring inside my home, and there may be others I've thrown out without
reading.

If there's money to be made by promoting fear, then fear will be
promoted.

- Frank Krygowski

In article ,
SMS wrote:

On 11/30/2010 8:28 AM, Peter Cole wrote:

We pay twice as much and get half as good. That's the bottom line.
Health care in this country is appalling. You are defending the
indefensible. You also have a conflict of interest. See the
connection?

Not all health care in the U.S. is like that. Obama even mentioned
some of the very efficient health care providers in the U.S. such as
Kaiser Permenante, whose whole idea was to bring health care to the
"common man." Oh, and it's a non-profit. Oh, and it was the only HMO
in California to receive a four star rating (Excellent) for meeting
national standards of care. None of the for-profits received that
rating. Kaiser isn't perfect of course, you have to know your way
around the barriers they put up to ration care, but overall they do a
good job.

That $200 band-aid is like the $10,000 NASA toilet seat. The cost of
everything in health care is burdened with a tremendous amount of
overhead that needs to be paid for.

In these discussions we also have to separate health care from health
care finance. Insurance companies are not health care providers, they
are health care finance providers. Doctors, nurses, etc., are health
care providers and are every bit as much at the mercy of the health care
finance problem as are the patients.

There's another reason that American health care costs are twice as high
as the next most expensive country: we have no government-imposed cost
controls except for the public options (Medicare, Medicaid, CHIP and
VA). Almost every other country controls health care costs pretty
stringently to very stringently; e.g., the UK does it through requiring
everyone to see a primary care provider before seeing a specialist,
Japan does it by micromanaging health care charges.

Pharmaceutical companies, medical equipment manufacturers don't really
care because these are all secondary markets- the primary market is the
US because there are no controls on the market. We use the fungible
notion of "usual and customary fee" instead. These companies make
almost all their profit in the US.

--
Gotta make it somehow on the dreams you still believe.

In article ,
"(PeteCresswell)" wrote:

Per SMS:
Kaiser isn't perfect of course, you have to know your way around the
barriers they put up to ration care, but overall they do a good job.

I belonged to the Kaiser plan for a number of years during a misspent
youth in Hawaii.

Granted, that was 40+ years ago, but my experience with Kaiser was
bad enough that I would never participate in an HMO again as long as
I could avoid it.

OTOH, I just went through a non-HMO-related minor surgical
misadventure at a prominent local hospital that didn't exactly
inspire confidence either.

A decade ago my wife discovered that she had an undiagnosed congenital
heart defect. She was 40 at the time and had HMO coverage (Group
Health, the HMO cooperative I mentioned in another post). She went to
the hospital, had open heart surgery and a pacemaker placed. Her
recovery was uneventful and her health is as good or better now than it
ever was before her surgery. Cost of the procedu $97,000. Out of
pocket costs: $90 (six outpatient visit copayments).

--
Gotta make it somehow on the dreams you still believe.

In article
,
Tom Ace wrote:

On Nov 30, 7:00*pm, Tim McNamara wrote:

Did you have to pay premiums to a plumbing insurance company for
several years in order to get a reasonable rate?

Another goofy question. *But it does demonstrate my point nicely,
which is that somehow we expect health care to operate as a
different sort of economy than other business sectors.

Tha's not a goofy question at all. It goes to the heart of one of
the suckier aspects of health care in the USA.

And it doesn't illustrate anything about wanting health care to be
different. If anything, it's about asking why it is an exception.
Pharmacies charge more money for the same prescription from an
uninsured customer than they do from someone with insurance. Same
product, and in the case of the uninsured guy the transaction is
simpler (cash and carry). This is not like most other businesses.

The people who pumped my septic tank were more professional and
ethical than many of the businesses I've dealt with for medical
needs.

Here again you are talking about health care finance rather than health
care.

Pharmaceutical companies charge X for their products (say, $170 for an
Advair Diskus inhaler product which lasts a month). That's the price.
Insurance companies get to negotiate a discount* because they are in
effect making a large volume purchase. It's like Trek ordering 10,000
bottom brackets from Shimano- they get a better price than my LBS who
orders 5 bottom brackets. Indeed, just like component manufacturers
compete for Trek's business, pharmaceutical makers compete to be on the
formularies of insurance companies.


* Unless it's Medicare, since the boneheads in Congress made it illegal
for Medicare to bargain down the costs of medications.

--
Gotta make it somehow on the dreams you still believe.

On Dec 1, 8:50*am, Peter Cole wrote:
On 11/30/2010 10:31 PM, Frank Krygowski wrote:



On Nov 30, 10:02 pm, *wrote:
On Dec 1, 1:21 pm, T m Sherm n _ ""twshermanREMOVE\"@THI

$southslope.net" *wrote:
On 11/30/2010 3:24 PM, James Steward wrote:
* *[...]

Anyone riding on the road with motor traffic is in constant mortal
danger.[...]

Anyone alive is in constant mortal danger.

I thought I mentioned that already.

Then James, try mentioning it more often regarding other activities,
would you?

I don't know if you can get Time magazine in Australia. *But the
December 4, 2006 American issue has, on page 68, an excellent graphic
and table discussing mortal dangers, i.e. causes of death in the US.
Maybe they did one for Australia, as well?

US deaths for 2003 are shown as a great 3 dimensional pyramid, divided
into horizontal slices by causes of death. *The largest volume slice,
at the pyramid bottom, is heart disease. *685,089 of those. *The slice
for "other diseases" not otherwise mentioned has 681,150. *For cancer,
556,902. *For stroke, 157,689. *Certain respiratory diseases,
126,382. *Diabetes, 74,219.

_All_ accidents combined cause only 4% of US fatalities, or 109,277.
Of those, the biggest sub-category by far is motor vehicle accidents,
_not_ including bike deaths, at 44,757.

Working our way down, we eventually get to choking on food (875) and
falling out of bed (594). *In between that are biking deaths, at 762.

762 out of 2.5 million annual deaths. *762 out of 109,277 annual
accidental deaths. *Somewhere between falling out of bed and choking
on food. *And you're afraid of dying while bicycling??

For someone who's critical of other's statistical thinking, that one is
a whopper.

Since it didn't make bicycling sound horribly dangerous, I knew there
would be objections. Some people simply can't stand the idea that
riding a bike is beneficial, not detrimental.

As far as I know, virtually 100% of people get out of bed at least once
a day, and eat many times more frequently than that -- compared to how
often they ride a bicycle?

There are many ways of talking about danger. "Safety!" fanatics often
talk about cost to society, as justification for all sorts of
restrictions or safety measures. (Bike helmets, of course, are one
example.) If we are to evaluate costs to society, then a table such
as the one I just described is an excellent starting point.

Also, given that we all must die of something, strokes, heart disease
and cancers are frequently diseases of old age, it's very misleading to
compare accidental death with inevitable death.

Except that the prime medical causes of death - i.e. heart disease,
cancer, strokes and pulmonary diseases - are all made significantly
less likely by regular, moderate exercise. You know, exercise like
riding a bike as part of your normal transportation, instead of riding
in a car. It would take very little cycling to reduce the 1.5 million
annual deaths due to those causes.

Yet you want the dangers, not the benefits, of cycling to be
emphasized. Why? Is the idea to NOT improve the 1.5 million deaths,
but instead to scare down cycling so as to slightly reduce the 762
bike deaths?

If you want to reduce the 762 bike deaths, enforce headlights at
night. Enforce riding on the correct side of the road. Keep cyclists
out of door zones. Educate drivers about our right to ALL roads, and
punish drivers who screw up. Don't yell that biking is terribly
dangerous. That's counterproductive.

Again, maybe things really are different in Australia - but then,
there's yet more data that I found. *The Australian Transport Safety
Bureau discussion paper, "Cross Modal Safety
Comparisons" (unfortunately, undated) claims 4.24 bicycling fatalities
per 100 million kilometers. *Oh, and for pedestrians? *16.12
pedestrian fatalities per 100 million kilometers - nearly four times
as high. *Once again, cycling is safer per km (or per mile) than
walking down the street.

For those used to thinking in miles, that's 14.6 million miles ridden
per bike fatality.

Maybe things are really different in your personal town. *Or maybe
_all_ Australia's bike deaths occur in your own neighborhood.

But if those remote possibilities are not true, you are certainly
overstating cycling's dangers. *Give it a rest. *You're not doing us
any good.

That number is 7x higher than the US auto rate.

Check the US auto rate for driving on country roads. IOW, omit the
freeway miles (since bicycles can't access the much safer freeways in
most areas). You'll find they are much closer.

Many people consider the
latter to be unacceptably high, and billions are spent to lower it. Just
more silliness, I suppose.

I approve of lowering the auto death toll. I suggest doing that by
lowering non-freeway speed limits, and by getting people to drive
less. I suggest doing the latter by educating them that cycling IS
acceptably safe right now, and even safer if done properly.

- Frank Krygowski