I am way overdue for some observations on the passing scene. Each topic here is surely worth one or more full posts. I will defer at this time, though if someone wants to comment and request a fuller dialogue, I’m game.

Black and white?
Ferguson. Staten Island. Cleveland. The news cycle has been feeding on events in these locations for months now. Unvarnished racialists are cherry-picking isolated, unrelated incidents to paint a demonstrably false narrative that white police systematically, intentionally, and criminally go out of their way to use deadly force against unarmed young, innocent black victims based solely on skin color. All of the situations are much more nuanced than that, as the grand jury decisions have indicated. And, as some courageous journalists have pointed out, it’s not hard to find shoes on the other foot that have not generated any interest from the dinosaur media, who won’t let balance get in the way of their chosen narrative. Their latest panacea: nationalize the police. What could go wrong?

Presumed guilty
Speaking of our friends (?) in the left-wing media and their narratives, the one about rampant rape culture is getting refuted big-time. Perhaps Lena Dunham would have benefited from some time in the gym rather that stitching together what is likely a libelous smear against a fellow Oberlin collegian. Plus, the story of gang rape at the University of Virginia is exposed as just that, a concocted story. We now hear that, even if these specific items are the fairy tales they have been shown to be, the circumstances demand that, contrary to the concept of due process of law that Western culture has honored for a millennium, the accused rapists are guilty until proven innocent. We must not stand for the destruction of the fabric from which our legal system is woven.

OCD on ICD?
On to my professional beat. The oft-delayed ICD-10 transition is yet again a political football. Those not in the business neither know, nor much care, about the controversy. Let’s just say that the current ICD-9 coding system is oh, so 20th century. The underlying problem is that the ICD classification systems, whether they be 9, 10, or 11, don’t correlate well with the goals of nomenclatures like SNOMED CT, which align more closely with electronic health record software. Until the twain shall meet, the tensions will persist, and whichever lobby is strongest in Mordor on the Potomac River will prevail. That is not the most intelligent way to decide such an important issue.

Sour mash Wisky
Now, a lighter topic. My home state Buckeyes barreled their way into the college football playoffs with one of the more dominating performances you’ll ever see, in their defeat of Wisconsin last night. Clearly tOSU made the most compelling closing argument. My main head-scratching question right now is, with the arm Cardale Jones showed us, why has he been riding the bench until now? Anyway, Buckeye Nation had its prayer answered, and if they can knock off Nick Saban’s Alabama crew, this team can be more than just an Urban legend. But the biggest takeaway was, exactly as I opined when the current playoff scheme was first foisted on us, that four teams do not a true championship playoff make. Even eight teams may not be enough. Ten to sixteen is more like it, but the required reduction of regular season gate receipts likely makes the logical solution a non-starter. Meanwhile, the spectacle still succeeds in drawing eyeballs to itself, which is all its purveyors really want.

Boys will be girls
Unfortunately, “what they want” in Minnesota seems to be the extermination of high school sports. The PC push to make sports programs transgender-friendly inevitably led to a ludicrous policy that appears to erase any distinctions between boys’ and girls’ teams. So, when all teams are co-ed, what opportunities will there be for 5-foot-5 girls to play varsity basketball? Does this further the competitive opportunities for 99% of young women? Is it worth it, just because Johnny is in denial of how God made him, and thinks he’s Janie instead?

What say you?

I have to admit, I watched some of the wall-to-wall, commercial-free, all-crisis-all-the time coverage on the Toledo TV channel yesterday. Yes, I have some initial thoughts on the situation. (No time to start disappointing folks now….)

First, as to the acute matter itself. Seems like the mayor and his team are doing a decent job of organizing the tasks involved with distribution of emergency water supplies to the community. I’d like to think the same holds in the suburbs and other communities who get their water from the Toledo supply, though at least on 13 news that does not seem to be noteworthy. Of course, the $64 question is when will the Toledo supply be safe, so that is where the focus understandably remains.

Again, this is solely based on what’s served up by the Toledo media, but it’s also heartening that people in the affected areas, and well outside of it, are pitching in to help and get water to those who need it most. There is only so much any level of government can do, and the success of such an operation inevitably depends on the bulk of the populace being altruistic. Kudos to everyone who’s helping!

One can’t help noting that a few politicians found opportunities to grandstand for votes for themselves and for their party, really grating at a time when affiliation shouldn’t matter. (Yes, Teresa Fedor, I mean you.) On the other hand, while it was doubtful that Governor Kasich had much of a shot at carrying Lucas County before this weekend, his delayed appearance (still pending at this writing) makes it certain that he’ll need to rely on other areas of the state to win a second term.

So what about the origin of the problem and how to remediate the region’s water woes over the longer term? There are multiple factors at play in the worsening of the algal blooms in Lake Erie, which are generating the harmful microcystin toxins. I’m sure there are idiots out there blaming it on global warming, despite this past July having been one of the coolest in memory. The unending stream of organic material deposited into Lake Erie, whether it be runoff from farms into the Maumee and other rivers, overflow from the aging Detroit storm sewage system that can’t handle the rains that it needs to, or other sources, simply has to be addressed. Readers of this blog will not be surprised to learn that I don’t believe this is a matter for intervention by the federales. In fact, I am confident that their heavy hand will only make things worse and more expensive all around.

No, this problem was created in Ohio and Michigan, and the two states need to stop sniping at each other, ‘fess up, sit down, and come to grips with a problem that won’t solve itself. Governors Kasich and Snyder, time to address the root cause before the EPA comes in with jackbooted force. Is it going to cost a lot of money? Yes. Is it going to upset agribusiness? Yes. Will the politicians make enemies? Yes, though arguably fewer that they are managing to create with the current circus.

Finally, while the local TV stations may be reaping a ratings bonanza given the way they have latched on to the crisis, I don’t believe they have served their audience particularly well. Viewers can only take recycling of the same handful of remote reporters at distribution sites, no news to report except that people are still lugging water bladders about, so often before getting tired of it. Same for the consumer reporter breathlessly informing us of price gouging (the fact that jerks will be jerks, even in a civic crisis, should be no news flash) and the meteorologists showing us every ten minutes where the algae are (and where they will probably be next week). Surely many interested viewers gave up on hearing anything new and switched to other fare. Better, I suggest, would be to announce that aside from breaking events like the next mayoral press conference (based on this morning’s performance, perhaps even that doesn’t qualify), the news folks will come on at the top of every, say, four hours with a 30-minute wrap containing only what’s, well, news. They can keep running their crawls across the bottom of the screen screaming, DON’T DRINK THE WATER! as a public service, but as for the blanket coverage, I think every local now knows what the bottom line is—and does not need it intoned every five minutes. Just sayin’….

No single topic today, just keeping the blog semi-warm while the mercury creeps back up as we expect in late July.

My health lately has been a mixed bag. I never have been able to shake the constant paresthesia in my right posterior thigh and lateral aspect of my right foot, which first appeared after my back injury in February. Neither gabapentin nor pregabalin seem to have had any effect. At this point, I must operate under presumption this will be permanent. Especially disappointing since it has affected my leg strength and gait. Whether spine surgery for the underlying pathology would help this, so many months out, is questionable.

Fortunately, the symptoms do not prevent me from getting in lots of walking time on the treadmill. And that brings me to the upbeat side of things.

Without having done a lot of research into it beforehand, I applied through the company’s wellness portal to participate in a weight loss program called Naturally Slim. Actually, though my weight loss goals were not prodigious, I have found it to be a very welcome aid to what I had already started with monitoring food intake. The primary emphasis in the regimen is on portion control, which I have always known to be my biggest problem. Where it helps the most is in putting some structure around the exercise: eating slowly to “taste every bite,” waiting until one is actually hungry to eat (which can zap snacking), and eating one food at a time. While I don’t profess to follow all the prescriptive habits, I have been able to add some of that structure into reducing the amount of food I eat each day. I know the NS gurus abhor calorie counting, but this quant can’t help it, especially when the Fitbit app makes it so easy. What I have been able to tell that since joining the NS program, my daily intake has dropped from the 1800-2000 kcal/day range to around 1400. The key will be, do the new habits I’m learning now result in the behavioral equivalent of “muscle memory” that will keep me in that same ballpark over the long haul?

Between that and the increase in calorie burn from exercise, the weight loss is coming right along. 24 pounds in a shade over two months. Other metrics are positive as well. Blood pressure is now in ideal range, and lipid profile done in June was better than I could have imagined. Perhaps at next PCP visit we try getting me off the lisinopril and atorvastatin and seeing how I do. Better living without chemistry?

Elsewhere in life. I have also been picking up the pace in the reading department. This is largely due to my next second-job endeavor, starting this fall as an adjunct faculty member in an online master of health informatics program. I just had to submit my syllabus for the fall course in healthcare IT networking and security, which required that I get through the required texts, as well as suggest some other readings for students that actually connect back to healthcare. I also cooked up some interesting writing assignments. The term begins in five weeks.

All of this, plus the regular work schedule, has cut significantly into social media presence. My Facebook time is way down, and I hope my much reduced volume of status updates isn’t disappointing to those who, I’m sure (LOL) hang on my every syllable of wisdom….

Last but not least, we have put some weekends aside in pursuit of Zora’s RAE (Rally Excellent Advanced) title. Having achieved all three of the basic titling levels in rally obedience, the objective here is to earn qualifying scores in both the advanced and excellent classes—at ten separate trials. Each one of these blessed events is referred to in the jargon as a leg, also sometimes termed a double Q or QQ. Well, after two QQs in Maumee at the beginning of June, and two each the past two weekends in Monroe and Moraine, Zora and Rita are up to six legs—though not to be confused with an insect. We return to Moraine for two more trials next month.

OK, enough computer time for now. I have a stack of print magazines to get through (hopefully with some useful nuggets of information I can leverage in one or more of my jobs) before the weekend is over. Stay cool!

This troubling story, authored and disseminated by the Associated Press, appeared in my local newspaper this morning. Those of us who work in healthcare and deal in protected health information (PHI) on a daily basis can only shake our heads in disgust at the woman who is alleged to have obtained PHI in order to defame another person. If indeed that is shown to have occurred, she should be liable for the damages that are awarded. But what about the hospital???

Disclaimers:

• I am not a lawyer and cannot pretend that my coursework on legal issues in healthcare, or my years of handling similarly sensitive PHI, constitute bulletproof legal thinking.
• I know only what is in the AP story, which does not appear to have picked up much embellishment in other news sources, with the single exception of the New York Daily News. There’s no assurance that the published pieces present all the facts of the case.
• I’m a former colleague of the hospital administrator quoted in the story.

On to my take.

The plaintiff’s gambit is clearly to invoke a wide blanket of the respondeat superior doctrine, which holds an employer liable for torts committed by its employee in the course of his or her employment. Those who have studied health law are well familiar with the concept and its impact on healthcare organizations whose employees may act negligently while providing patient care or other medical services. Note that plaintiff’s attorney indicated the plan of attack by boasting, “They can’t hide behind a shield of, ‘This employee was acting outside of the scope of their responsibilities.’ If that’s going to be their defense at trial, I’m looking forward to the trial.”

His argument rests on the judicial consensus that when an employee is clocked in to work, at the workplace, and using the tools provided by the employer (in this case, computer and patient billing system), the employer is responsible for the bad actions of the employee. Broadly speaking, that’s correct.

But, as Lee Corso says, not so fast, my friend.

A little closer read of the bounds on scope of employment, with relation to an employee’s action, is that it must be performed “at least in part, by a purpose to serve the master” (Dobbs D, Keeton RE, Owen DG: Prosser and Keaton on Torts. Keeton WP (ed). St. Paul, West Publishing Co, 5th Ed, 1984, pp 501-502). When the defendant employee allegedly looked up the patient’s billing record at the instigation of the rather unsavory male sexual contact of both (I was going to say love interest, but I doubt there was much real love involved), the action cited cannot possibly be construed as one which even in part served the interests of the hospital. Not in any way.

If the UC Medical Center is held liable in this case—despite presenting (one assumes) the proper documentation that the employee was trained in responsible use of PHI, her agreement to follow the policies she willfully breached, and the appropriate audit trails, not to mention the fact that it fired her upon learning of her act—think of the chilling effect it could have on all manner of organizations in the medical services industry. People in billing departments, by definition, need to be able to access, well, billing records. How else does a hospital reasonably deter the scoundrel within its walls who is determined to steal information he or she is not entitled to see, much less cause to be plastered on a social media site?

I could, and perhaps may in the future, additionally weigh in on other themes in this story. For instance, it does not appear that the plaintiff denies that she indeed contracted an STD, just that the distribution of that fact on a Facebook group led to harassment and emotional distress. (Guessing the Walmart in Cincinnati was sold out of big-girl panties.) And what about Facebook itself? Maybe they should try to name Mark Zuckerberg in the lawsuit as well, since he was obviously complicit in allowing a group named “Team No Hoes” to exist on his company’s platform.

Bottom line: bad actors will behave badly, regardless of the avenues available to them. If you run me over with a Chevy, am I free to sue GM?

(picture retrieved from http://assets.nydailynews.com/polopoly_fs/1.1817389.1401923982!/img/httpImage/image.jpg_gen/derivatives/article_970/university-cincinnati-medical-center.jpg?enlarged)

Nothing profound or political today. As I root for the elusive sun to come back out and warm us up—it appeared oh, so briefly a bit ago but retreated again—I guess I’ll just stay on the treadmill a bit longer instead.

I now have a few days with the Fitbit Flex under my belt. Literally, as it happens. Yes, I know it is supposed to be worn on the wrist. But I have been of the tribe that usually holds onto the treadmill rails while doing my brisk (about 14 minutes to the mile) walks. (Go ahead and abuse me, Jillian Michaels!) As I had discerned from my research, that habit definitely does not pick up most of my steps. But attaching the bracelet around my belt does. That way I can continue getting virtual credit for the calories I am burning.

It really is like a game, and one I do not mind playing. I have been relatively good with staying within my calorie limits. But so far I find that even while the Fitbit app “permits” more food calories when more exercise is tracked, after days like yesterday when I burned a lot and ate accordingly, the number on the scale (the most important one!) went the wrong direction. So, given that Rita has declared tonight to be pizza night, I am pretty much starving myself until dinner time, and racking up a goodly quantity of steps, distance, and active minutes.

Indeed, and this is no news flash, my main problem has always been portion control. And keeping a food diary is one powerful way to help keep that aspect in check. It has been a few years since I last went that route, and the tools are better today. Last time around, I used a clunky BlackBerry app whose name I do not even recall (was there EVER a BlackBerry app that wasn’t clunky?); tracking food on it was so onerous I only kept up with it for a couple of weeks. While the Fitbit app and website aren’t perfect by any means, they are a big improvement. Hopefully I can stay on the “program” long enough to make a big difference on the scale.

The other developing story for me at present is continuing progress toward coming on board as an adjunct faculty member for a local college’s health informatics program. More on that when the deal is sealed. But we’re projecting first eight-week course this fall on networking and security in health IT. There’s certainly no shortage of news stories these days in the HIT security world, and I am keeping a virtual clipping file to supplement whatever readings are in the syllabus. Watch out, students! 🙂

Disclaimer: I’m not asserting much in the way of original thought in this post, rather summarizing some of the better arguments I have encountered in the recent wake of the tawdry episode of Donald Sterling. Surely some of my few readers have not been exposed to anything other than the mainstream script: crusty NBA team owner spews racist barrage at his girlfriend, and gets banned for life for his crime of hate speech.

Yes, Sterling is a bigot and a racist to boot. And it’s jarring to grasp the concept that his claim to fame in recent years has been as proprietor of a basketball team which, like any other that hopes to be competitive talent-wise, is comprised predominantly of black players. Understandably, the stars on his payroll reacted negatively to the words he spoke privately but were leaked to the public.

But, why is the outrage not arising until 2014? And why is the public destruction of the man predicated on words, and not on the truly deplorable actions Sterling has engaged in for decades, earning the well-deserved appellation of “slum lord”? Have we forgotten the nursery rhyme of our childhood, “Sticks and stones will break my bones, But words will never harm me”? (BTW, according to Wikipedia, that rhyme is attributed to a black Methodist church publication.) It is because, in the so-called modern age, deeds matter less than words.

For that matter, how about the deeds perpetrated by some of the NBA “role models” whose transgressions received far less, and in some cases no, punishment? Let Ben Shapiro remind you of some of the most glaring examples.

Indeed, how about today’s dissolving of any distinction between remarks uttered privately (and intended to remain so) and those issued publicly? In an age where most everyone carries a device capable of recording private conversations—i.e., a phone—one no longer has the presumption of keeping his or her utterances confined to the person to whom they were spoken. (Never mind what the NSA may have stockpiled on you, me, and every other person who speaks or writes!)

So what’s the next frontier for the speech police? It’s a given that the owner of the Orlando team will need some Magic to avoid the blackball, based on his support of an institution (traditional marriage, for centuries a sacrament but now a civil entitlement!) that is out of step with the times, or is it “The Times“?

Yes, the NBA is a privately run league, and it has the prerogative of accepting or banishing individuals without interference from others. But, speaking of interference, along comes corruptocrat politician, and former NBA player, Kevin Johnson. Mr. Johnson, current Mayor of the People’s Republic of Sacramento, inadvertently let his slip show, revealing the motive shared by not a few of ilk when he intoned that “sports provides a place for fundamental change for how our country should think and act.”

WHAT?!?!?

I have no doubt that Mr. Johnson and his crowd believe that to be literally true. They also possess the power to enforce those standards by fiat. And if that happens, get ready to be slam dunked.

Also see incisive commentaries by Steve Deace and Thomas Fleming, among others.

I don’t mean to identify in the title with the profane and hateful screed some might call “music,” rather to reflect on the hand-wringing that has been occurring in my business over the last week or so. I refer to the crap sandwich that sailed through Congress just in the nick of time to kick down the road the can known as the sustainable growth rate (SGR) cuts in Medicare payments to physicians.

Warning: for those not in the medical services industry, there’s lots of inside baseball involved. I’ll try not to get too bogged down in the details; rather, I’ll try to interpret this mess for lay people.

Back in 1997, the magicians in DC pulled a rabbit out of their hat with the Balanced Budget Act. One of the tricks up their sleeve was the way they made the numbers work out with respect to physician reimbursement under Medicare. If too much is paid out one year, the rate for the next year is supposed to be cut by a similar amount. (Otherwise the budget wouldn’t balance in the out years.) Except that every year, the doctors’ lobby has successfully convinced the Congress critters to okay a postponement of the cut. It’s literally known in the business as the “doc fix.” They, figuratively, roll the snowball down the hill, and the amount in question keeps getting bigger and bigger. So now, in 2014, without either a permanent solution or another doc fix, Medicare payments to physicians would have been slashed 24% on April Fool’s day. (How apropos.)

Of course, “Congress” and “permanent solution” do not belong in the same sentence. Though some alternatives were floated, none of them stood, um, a snowball’s chance in hell given the dysfunctional nature of our current legislative branch. Thus, another doc fix was drafted. And, somewhere along the line, lobbyists (who have not yet come forward to claim responsibility) managed to add various ornaments to the bill, causing it to resemble a mistimed Christmas tree. It got the rush treatment due to the tight deadline. And, not surprisingly, it has come to be like another one of Forrest Gump’s box of chocolates. At least one provision, for additional mandates around imaging systems, was never reported on until after the bill passed.

Two other provisions, which were talked about in the trade press, amount to a yummy caramel and one of those coconut-filled ones that a person either loves or hates. The first delays enforcement of the hated two-midnight rule that CMS imposed upon hospitals last year, under the aegis of Obamacare. What—you don’t know about the two-midnight rule? Read here what kind of havoc it is going to wreak on seniors across the country, even before it’s enforced. The other delays, by at least a year, the deadline for healthcare organizations to bill using the new (relatively speaking; it has been out there since 1992!) diagnosis code set known as ICD-10. Because many existing billing systems were hard-coded for the previous version, ICD-9, lots of health IT folks have been in a mad dash to meet the October 1 deadline. It has been likened to healthcare’s version of Y2K.

Nobody, yet, really knows who snuck the ICD-10 adoption delay into H.R. 4302. But it is now law, and the CMS chief who promised health IT leaders in February that there would be no more delays—I hopes she likes eating crow.

To me, by far the bigger issue is that my industry now toils at the whim of the likes of John Boehner, Nancy Pelosi, Harry Reid, and Mitch McConnell, along with their cronies. We signed that deal with the devil many decades ago, when we allowed our “leaders” to insert government into the health insurance business; it started with Medicare and Medicaid, and the slope has been getting more slippery ever since. This is a dance many of us don’t like, but without radical alternatives, we have little choice but to snuggle up to our diabolical partner.

I am doing some research into the dissident outfit out in the heartland, the Surgery Center of Oklahoma. Seems like a promising model, if only we can extract our Medicare population from the grips of Congress, the CMS, and their whims. I’m tired of dancing….

(As always, posts on this blog reflect my views alone, and not those of my employer.)

While I spent my pre-adolescent years in the 60s, I recall little of the civil rights struggles of that decade, other than staring in wonderment at the TV as Huntley and Brinkley showed us footage of Watts and Detroit burning. So I admit I can’t speak with ultimate authenticity about the emotions from that time—though I can reflect on what is happening in this time. We hear the trope that it’s not possible for minorities to be racist, as they were the ones oppressed in the first place. If the tables are being turned, that just makes things “fair.”

What a pile.

Human beings, by virtue of being endowed by their Creator with certain inalienable rights (remember that insignificant piece of parchment called the Declaration of Independence?), are protected from being harmed by acts of force (bodily and otherwise) exerted by others. The Constitution (remember that one?) lays out the limits on how the national government may, and may not, assure that basic liberty. These documents make no intrinsic distinction on skin color. Yes, slavery was a gross moral injustice, and the Framers were sadly unable to eradicate it in their day. But it did eventually meet its demise, and so did the government-sanctioned restrictions on civil liberties that sprouted in its aftermath. Yet, some few out there seem to believe that two wrongs do make a right. Witness the gruesome spectacle that played out in Detroit this past week. An unfortunate black youth darted into the oncoming path of a white motorist who could not stop in time, causing an injury to the child. As any morally upstanding citizen might be expected to do, the driver stopped, exited his vehicle, and came to tend to the youngster. He was rewarded for this behavior by getting brutally beaten by a dozen street thugs. One witness candidly told the Detroit Free Press, “He got his.”

What have we come to?

Disclaimer here. Granting that Atlas Shrugged is a 20th century masterpiece that in many respects is sadly prophetic, there’s a lot I find disagreeable with the outlook of Ayn Rand. But not when it comes to racism. Here are a couple of Rand quotes that apply, courtesy The Ayn Rand Lexicon.

Today, racism is regarded as a crime if practiced by a majority—but as an inalienable right if practiced by a minority. The notion that one’s culture is superior to all others solely because it represents the traditions of one’s ancestors, is regarded as chauvinism if claimed by a majority—but as “ethnic” pride if claimed by a minority.

Racism is the lowest, most crudely primitive form of collectivism. It is the notion of ascribing moral, social or political significance to a man’s genetic lineage—the notion that a man’s intellectual and characterological traits are produced and transmitted by his internal body chemistry. Which means, in practice, that a man is to be judged, not by his own character and actions, but by the characters and actions of a collective of ancestors.

The gang who bashed Steve Utash’s head in judged him based on their perception of “a collective of ancestors.” This is what happens when the laws of nature and nature’s God—on which our society and culture were once based—are supplanted by a victim mentality that justifies the violent restriction of another’s basic human rights.

It wasn’t right when one tribe oppressed another two centuries ago. It isn’t right today. Will those in power affirm their oath to uphold the Constitution of the United States? Oops, didn’t think so.