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Crashrat posted:Everyone keeps bringing up customization in this. There is so much poo poo going on with our build that I can imagine sometimes these issues manifest and sometimes they don't. Our registration system is decades old and only has M and F listed as options in the sex field, so I'm going to guess that partially drives what we see in Epic. That said, once you receive your live build, there is a TON of poo poo that can't be fixed, because when you try it breaks three other functions. No kidding, when I order a genital swab for STDs, every single time I have to choose between genital and urine source even though the source is literally in the order name, because attempts to fix it screwed up other things. There's so much that confuses me about our Epic ASAP implementation that I could write about it for days. Epic blames the hospital's choices, and the hospital implementation people blame poor feedback and overall responsiveness.
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Oct 7, 2017 14:05
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https://twitter.com/Phil_Mattingly/status/916656976607752192
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Oct 7, 2017 15:09
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The Phlegmatist posted:So yeah, I guess it is a major concern if Epic considers patient data and a patient's EMR to essentially be the same thing. Which is dumb. From what has been posted, that's exactly what it sounds like. If most of the patient's info is already in the EMR, I can easily see someone making the decision to collapse the two records into one (or just never thinking to do that from the beginning). Crashrat posted:The only way I can see any logical reason for this is that Epic is just trying to *force* some kind of progression in the medical field by making the patient's chosen sex visible. That is highly unlikely. Lazy/non-thoughtful developers or being designed a decade ago or later* are the more likely explanations. This ties in to how programs are designed and use information. Gender would be defined as a custom value and, probably in this case, is defined as [MALE] or [FEMALE]. Now, increasing the definition of the Gender type to include the appropriate trans values would be trivial. What would not be trivial is making sure that everything works as it should. The biggest hurdle is that Gender is attached to the patient's EMR, which, I imagine, is used by the entire Epic system. By adding in those definitions, every part of the Epic system will need to be updated to know how to use these new values correctly. They'd also need to test everything in general to make sure that the old definitions still work, because, surprisingly, that stuff can break or cause stupid issues from these changes as well! Not to mention making sure that EMR's from the previous version import correctly as well. I'm not saying that Epic is excused from doing nothing on this issue but trying to explain why it would require a significant amount of work and investment on their part. Regarding customization, this is one of those areas where it has to be hard-coded into the system. The head of IT at a hospital can't just whip up a new Gender value for their system because of how it is handled by the system. *This is just a simple matter of most people from not being knowledgeable about trans issues at the time. quote:"a regular person" Minor thing: if this is your way of saying that you're "not trans", the term you're looking for is "cis". If you have problems with that term, just say "not trans" instead.
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Oct 7, 2017 21:00
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https://twitter.com/WSJ/status/916773149538177024
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Oct 7, 2017 22:14
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tetrapyloctomy posted:That said, once you receive your live build, there is a TON of poo poo that can't be fixed, because when you try it breaks three other functions. No kidding, when I order a genital swab for STDs, every single time I have to choose between genital and urine source even though the source is literally in the order name, because attempts to fix it screwed up other things. I'm the gigantic software company that can't figure out unit testing. Seriously I don't know why people are worried about automation in healthcare; the whole drat thing is a comedy of errors. Watson's oncology program is currently deployed globally but there are a whole lot of problems with it. It's being trained by whitepapers and oncologists at MSKCC. MSKCC is a world-class cancer treatment facility that gets complicated cases and all their patients are fairly affluent. You can imagine how this introduces ridiculous bias into Watson's suggested care methods. So then when Watson is deployed in a rural hospital in India it will just suggest poo poo they cannot afford and also Watson never actually explains the reason why it's recommending a certain treatment, which makes physicians not trust it. So either it recommends what the physician already wanted to do or it disagrees; in the first case it's an electronic cheerleader and in the second it's entirely worthless.
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Oct 7, 2017 22:41
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The Phlegmatist posted:I'm the gigantic software company that can't figure out unit testing. For those that aren't familiar with the company, everything backend related is written in this: https://thedailywtf.com/articles/A_Case_of_the_MUMPS And they mainly hire new grads and burn them out within 2 years
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Oct 7, 2017 23:36
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hobbesmaster posted:For those that aren't familiar with the company, everything backend related is written in this: https://thedailywtf.com/articles/A_Case_of_the_MUMPS They've got a really good campus recruiting program. I remember thinking I hosed up an interview and was super pissed about it. This was back before the days of a billion rate your job websites. In retrospect it was probably a good thing.
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Oct 8, 2017 00:10
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hobbesmaster posted:For those that aren't familiar with the company, everything backend related is written in this: https://thedailywtf.com/articles/A_Case_of_the_MUMPS What the ever living gently caress did I just read? Nothing about that programming language makes sense. It's like someone watched the movie "Brazil" and decided to make a programming language that as closely mimicked the ethos of the movie's universe as possible. Just reading the fact that made my brain cry.
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Oct 8, 2017 06:43
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hobbesmaster posted:For those that aren't familiar with the company, everything backend related is written in this: https://thedailywtf.com/articles/A_Case_of_the_MUMPS GE uses the same thing. MUMPS is an epidemic in the healthcare industry, pun intended. It was funny when we deployed Centricity and had to buy new servers to run the backend for a language that should have been dead and buried thirty years ago. Also for some more fun healthcare tech stuff, we have a server on the intranet running Red Hat Linux 6.2. No, not RHEL 6.2.
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Oct 8, 2017 17:58
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Welp https://twitter.com/ASlavitt/status/917886129382162432
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Oct 11, 2017 15:01
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For those that haven't been keeping track, the EO he's talking about will allow people to pool together across state lines to make insurance "associations" that do not fall under the ACA rules. An example state is Tennessee where such associations have basically crippled the insurance market because it is nothing but a high risk pool now. Slavitt believes that this is step #1 in the executive crippling the ACA by any means necessary in order to payback the repeal promise to donors since republicans are worried about 18.
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Oct 11, 2017 15:10
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If Americans really value healthcare, they'll find the money to pay for it.
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Oct 11, 2017 18:56
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Mr. Nice! posted:For those that haven't been keeping track, the EO he's talking about will allow people to pool together across state lines to make insurance "associations" that do not fall under the ACA rules. An example state is Tennessee where such associations have basically crippled the insurance market because it is nothing but a high risk pool now. Slavitt believes that this is step #1 in the executive crippling the ACA by any means necessary in order to payback the repeal promise to donors since republicans are worried about 18. Every insurer out there is constantly winnowing away at their networks to get things narrower and narrower for their low-cost options - the BCBS Advantage plan fights with hospital groups over the past couple years easily comes to mind wherein BCBS threatened to fully drop the network if their lowest-cost plan wasn't accepted, which the hospitals accepted albeit for a very narrow list of doctors. Cheaper plans are virtually by definition narrow plans typically with longer waits to see specialists. Trump's plan is effectively saying he's going to single handedly, with a mere EO, reverse decades of trends in private health insurance...and that somehow these wide plans will be cheap. The only way they're "cheap" is if the premium is low, but there's a gargantuan deductible and OOP max. Do we have any real proof that people will actually sign up for these plans? There's people who can't be bothered to log into their state exchange or Healthcare.gov to sign up, and that's a massive complex of integrated systems that are pretty easy to use as of now...but yet people still get confused or can't be bothered to sign up. The entire thing hinges on already-existing associations to decide to go through the hassle of offering their own insurance plans. I can definitely see some conservative groups doing this, and it'll backfire spectacularly when those people suddenly can't get access to their doctor or they have massive medical bills... But I just can't forsee millions of people joining these sorts of plans. I have a hard time forseeing hundreds of thousands of people joining them. At most it would be in the tens of thousands - the really diehard people that are champing at the bit to  about not being in Obamacare anymore - but I've seen nothing to show that the people who hate the ACA in public are simultaneously willing to make the private decision to effectively destroy their healthcare options just to spite the ACA.
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Oct 11, 2017 22:40
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I do not know a single person who is insured by an association health plan.
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Oct 11, 2017 22:52
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The aarp plans are some of the most popular med supp, med c and med d plans. Kind of a different animal than the pre65 market though
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Oct 11, 2017 23:25
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Crashrat posted:Do we have any real proof that people will actually sign up for these plans? The CBO score for the 2003 bill (I am not kidding when I say GOP congress critters have been at this for a long time) estimated 25% of the small-group market would move to associations. The Mercer at the same time study estimated it to be about 50%. This came with smaller premiums for the associations and larger ones for those participating in the more regulated small-group market. There's no real data or estimates for what it would do in a post-ACA insurance system. It poo poo all over KY's small-group market but that was in the 90s. Here's the American Academy of Actuaries brief on the problems with AHPs and here's a study done on potential effects in CA in 04 The most pressing question currently is what the hell Trump can even do with an EO because this is something that requires federal legislation due to all the legal issues surrounding implementation. e: blue states can say "hey cool I remember MEWAs. and also those court cases." and regulate AHPs or block them entirely. red states could already have AHPs if they wanted them. I think any AHP created as a result of the EO is going to be scam insurance trying to skirt the law. The Phlegmatist fucked around with this message at 23:56 on Oct 11, 2017 |
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Oct 11, 2017 23:51
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The Phlegmatist posted:The CBO score for the 2003 bill (I am not kidding when I say GOP congress critters have been at this for a long time) estimated 25% of the small-group market would move to associations. The Mercer at the same time study estimated it to be about 50%. This came with smaller premiums for the associations and larger ones for those participating in the more regulated small-group market. A big problem is that all of the studies on this kind of thing (that I've seen) were all done pre-ACA and don't take into account the realities of the current ACA market. Rand Paul has been saying that these AHP plans would evade ACA regulations -- which could mean that they'd be subject to different pricing for those with pre-existing conditions and be ineligible for ACA subsidies. Which would make them, obviously an enormous poo poo sandwich that nobody would want unless scammed into buying one.
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Oct 12, 2017 00:19
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Old Kentucky Shark posted:A big problem is that all of the studies on this kind of thing (that I've seen) were all done pre-ACA and don't take into account the realities of the current ACA market. Nah, they're definitely all pre-ACA. The problem I see is that historically scam plans become really successful in years that have double-digit premium increases. Which is next year, for sure, due to CSR fuckery. Then you add that to the fact that there's uncertainty about ACA and Trump is doing something to fix it by creating these new plans. So that opens up a nice marketing avenue for AHP scammers. You could probably get a bunch of people buying MAGACare or whatever. Technically the pricing of the plans (re. them not being subsidized) doesn't actually matter because they "pay" providers in the same way that they "cover" your preexisting conditions. They're not actually underwritten so whoever is running these things can charge whatever amount of money they think would seem realistic to people and not obviously bullshit. Scam plans have also been rare enough that they're not in public consciousness. So I think there's a definite area for them to gently caress over a lot of people next year especially with the AHP thing. Aside from that I don't think Trump's EO will be a huge deal.
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Oct 12, 2017 00:43
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Old Kentucky Shark posted:A big problem is that all of the studies on this kind of thing (that I've seen) were all done pre-ACA and don't take into account the realities of the current ACA market. Rand Paul has been saying that these AHP plans would evade ACA regulations -- which could mean that they'd be subject to different pricing for those with pre-existing conditions and be ineligible for ACA subsidies. Which would make them, obviously an enormous poo poo sandwich that nobody would want unless scammed into buying one. The worry is the rise of plans that are super cheap for people who are young and have no pre-existing health issues, which could cause a drain of healthy people from traditional insurance plans. Healthy people leaving traditional plans will cause a rise in the average claim amount per insured under traditional plans, which means higher premiums for those who can't flock to the cheap "young and healthy people only" plans. Bonus points if these new plans can reject people at yearly renewal if their status ever changes away from "young and healthy". The drive is definitely within the GOP to create this situation, and every EO, court decision, and local/state law that makes this more likely is a bad thing.
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Oct 12, 2017 03:08
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A GIANT PARSNIP posted:The worry is the rise of plans that are super cheap for people who are young and have no pre-existing health issues, which could cause a drain of healthy people from traditional insurance plans. Healthy people leaving traditional plans will cause a rise in the average claim amount per insured under traditional plans, which means higher premiums for those who can't flock to the cheap "young and healthy people only" plans. Bonus points if these new plans can reject people at yearly renewal if their status ever changes away from "young and healthy". According to The Commonwealth Fund 49% of people with marketplace coverage found it "easy to pay" their premiums, and that number only drops to 48% when you go to below 250% of FPL. The same study shows that low-income adults with Marketplace coverage tend to pick plans with deductibles below $1000 - only 45% had plans with a deductible of $1000 or more - as high deductibles were largely picked by people with high incomes. Finally over 60 percent of people, consistently since April 2014, say their care was only affordable because of the Marketplace. Further utilization is up from 60% in April 2014 to 72% in April 2016. But we still have 12.7% of all working adults uninsured. 18.1% of young adults (19-34) are uninsured. So we have * Basically half of the people in the marketplace, including low-income, that find their premiums "easy to pay." * Low-income people pick plans with low deductibles. * A solid majority of marketplace users are only able to afford their care because of their new marketplace plans. * Utilization of marketplace plans is trending upward to almost 3/4ths of every adult with a marketplace plan using their plan each year. So what I read into this is that low-income people who've bought a Marketplace plan are finding it working, they pay attention to their deductible, and they're likely using their plans. All while we still have a decent chunk of people without insurance for whatever reason. ---- Am I missing something to read into this that a good chunk of Americans are actually quite happy with their plans, can afford their plans, and are using their plans? That's not the sort of formula that equates to suddenly risking a massive change. Trump's proposal may very well just end up tapping into the population who've refused to get insurance - maybe the Rand Paul aspect gets them to decide to try it - in which case their effect on the Marketplace risk pool is nothing. TL;DR Marketplace users are mostly happy with their plans, find them affordable, and are using them. I honestly think the only people who would risk trying the Rand/Trump association option will be people who are rabidly anti-ACA and don't even have insurance. In which case their effect on the Marketplace risk pool is nothing since they're not defecting as they've never participated.
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Oct 12, 2017 05:48
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Block grants own because blue states make it work and red states kill their nazi citizens.
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Oct 12, 2017 13:53
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Crashrat posted:Am I missing something to read into this that a good chunk of Americans are actually quite happy with their plans, can afford their plans, and are using their plans? While I'd love to believe that people who care/need to continue with ACA plans will read the fine print, we're talking about Americans. "But it doesn't cover 90% of what you need or actually currently use" will be overridden by "I can save 50% of any amount a month? YES!"
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Oct 12, 2017 13:55
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call to action posted:Block grants own because blue states make it work and red states kill their nazi citizens. I too am unaware of all of the minority citizens in red states, especially black people in the South, who don't deserve such a fate.
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Oct 12, 2017 14:02
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Cheesus posted:Only the consumer logic of "a cheaper product is better regardless of quality". 2018: "I can get a healthcare plan for half the price? Thank you President Trump!" 2019: "What do you mean this healthcare plan doesn't cover the condition I was just diagnosed with? Curse you, Democrats for not warning me! You liberals don't care about the white working man! All you care about is helping gay minorities!"
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Oct 12, 2017 14:48
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call to action posted:Block grants own because blue states make it work and red states kill their nazi citizens. Unfortunately due to the ineptitude of the Democratic Party the only true blue states are California, Oregon, Hawaii, Rhode Island and Connecticut.
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Oct 12, 2017 16:55
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https://twitter.com/sangerkatz/status/918670072679469057
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Oct 13, 2017 03:55
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I'm surprised they actually went and did it. Insurers have already assumed CSRs were going bye-bye for a while without the WH making an official statement and priced their plans accordingly. This seems like a bizarre political self-own.
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Oct 13, 2017 04:48
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The Phlegmatist posted:I'm surprised they actually went and did it. Insurers have already assumed CSRs were going bye-bye for a while without the WH making an official statement and priced their plans accordingly. Actually it's a bizarre political everybody-own
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Oct 13, 2017 04:51
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I don't understand how the Republicans are going to spin this. They're cutting $7bn in funding for CSRs all to...spend an extra $200bn in premium assistance? In what world is any of that sane whatsoever?
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Oct 13, 2017 05:20
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Crashrat posted:I don't understand how the Republicans are going to spin this. It's making nasty dirty ObummerCare go away. If OblunderCare has never been introduced, then all this carrying on about getting rid of ObaddyCare wouldn't be causing so many problems. That's literally the logic. It's like that meme of putting a stick through your own bike spokes.
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Oct 13, 2017 05:34
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jivjov posted:It's making nasty dirty ObummerCare go away. If OblunderCare has never been introduced, then all this carrying on about getting rid of ObaddyCare wouldn't be causing so many problems. Oh I totally get how the idiotic base voters see it, but those people literally don't care about anything beyond their politics of hating anything and everything that might be remotely called "liberal". Basically if it's something that would cause their "liberal" acquaintances to get angry - they love it. I have no doubt those people are quite happy. --- I'm talking about everyone else. Even Orrin loving Hatch said the CSRs had to keep being paid. Orrin Hatch for gently caress's sake. We're going into the election with these CSRs removed and huge premium increases. The lowest income people may turn out okay - the shear amount of extra premium assistance they get may offset it all according to the CBO - but the middle class people are going to be utterly hosed by those premium increases. Republicans will be owning that - both for their failure to pass reform and Trump's decision to sabotage the market. The GOP should have been jumping for joy with the chance of full government control by taking the Senate in 2018. This non-stop cavalcade of awfulness with absolutely nothing on the horizon to point to improvement - the chances of them actually getting tax reform through at this point are terribly slim. They've got about 30 days of time before the holiday period starts (with all the State Work Periods away from Congress itself) and once 2018 hits the electoral posturing for the House and Senate races begins. I can't see how any of this works out in a positive way. Especially if those 17 state Attorneys General decide to make a big public showing of their intent to continue to defend the case for CSRs being able to be distributed - since they were given permission to do that as the Trump administration didn't want to defend it - results in a whole new flank of bad press. All pointing to an all too real election cycle of pretty much nonstop bad news for Republican candidates. ...and that's all assuming there's no major bombshell from the Mueller pressure cooker that's been over there going full-tilt.
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Oct 13, 2017 06:19
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If premiums go up because of uncertainty, won't insurers have to refund most of the increase due to the limit on premium:benefit ratio?
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Oct 13, 2017 13:04
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Crashrat posted:We're going into the election with these CSRs removed and huge premium increases. The lowest income people may turn out okay - the shear amount of extra premium assistance they get may offset it all according to the CBO - but the middle class people are going to be utterly hosed by those premium increases. Republicans will be owning that - both for their failure to pass reform and Trump's decision to sabotage the market.  "
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Oct 13, 2017 13:31
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oldskool posted:"Your healthcare costs went up and your coverage went down? Well we tried to repeal this obviously failing Obamacare but you didn't want to listen and now what we said was going to happen, happened I think it would to some extent, but it would probably "push the system to the limit" in terms of costs and probably also limit the number of providers since I am sure many of them are looking at a thinner bottom line. At the end of the day, the premium subsidies themselves aren't going to disappear because they have to be repealed by Congress, but it will almost certainly impact the market.
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Oct 13, 2017 13:35
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I know this was pretty much the entire point of the last round of ACA litigation, but I won't lie and say I entirely understood the issue. To what extent are the CSRs statutorily required, and to what extent does the president have the discretion to fund them?
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Oct 13, 2017 15:16
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I think I've posted this in this thread before, but since the big dumb orange baby actually did it, I'll say it again. There's a pretty good chance not paying CSRs will hilariously backfire on the president and end up reducing net premiums by increasing the premium subsidies (APTC) substantially. Since insurers have to provide the increased benefits that would be funded by the CSR, they are able to increase the rates on their silver plans to account for these increased benefits. However, the silver plans are also what determine the level of the premium subsidies. If you make 400% of the federal poverty level or less, your premium is a fixed amount based on your income. If the second lowest silver plan goes up $100 a month to cover the big dumb babies refusal to pay CSRs, you'll just get an extra $100 a month in premium subsidies to cover it. You can still either buy up to a gold plan or buy down to a bronze plan and use this extra $100 dollars, so there's a pretty good chance this actually makes bronze plans significantly cheaper. The only people this could significantly impact are people above 400% of the FPL buying silver plans off-exchange, but they can just buy bronze or gold plans and not be affected by this.
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Oct 13, 2017 15:30
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Reik posted:I think I've posted this in this thread before, but since the big dumb orange baby actually did it, I'll say it again. So people making like 60-120k per year needing silver or gold plans like... 50-64 year olds? That's Trump's biggest demographic
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Oct 13, 2017 15:34
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Lote posted:So people making like 60-120k per year needing silver or gold plans like... 50-64 year olds? That's Trump's biggest demographic Gold plans will be fine because the increase in premiums will only be applied to the plans that qualify for CSRs. But yeah, hilariously backfire.
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Oct 13, 2017 15:34
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Flip Yr Wig posted:I know this was pretty much the entire point of the last round of ACA litigation, but I won't lie and say I entirely understood the issue. To what extent are the CSRs statutorily required, and to what extent does the president have the discretion to fund them? They are required by the text of the ACA but Congress did not appropriate funding for it. Congress sued Obama to stop payment of the CSRs because of this issue
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Oct 13, 2017 15:39
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esquilax posted:They are required by the text of the ACA but Congress did not appropriate funding for it. So what happens if Congress appropriates the funding? (I don't imagine there's a clear-cut answer here.)
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Oct 13, 2017 16:07
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