Tuesday, February 20, 2018

Told You So

Some nine years ago when we started this process I noted that the Electronic Health Record, as proposed by the previous administration, would be a disaster. First it was designed by an academic, second it was driven by the Government, and third it was provider specific rather that patient specific.

Now comes JAMA and the Harvard Gazette who states:

Electronic health record systems doesn’t reduce costs for bill processing. In fact, a study finds that it leaves primary care services with an average $100,000 tab per provider.

 Providers now have to hire scribes to record the EHR content. Each provider does not interconnect with others. For example in New York Presbyterian, a fairly decent provider, I have an ophthalmologist at Weill Cornell and a urologist at Columbia. The systems do not interconnect and they are on different platforms. Not that urology and ophthalmology need to connect, not even I can find a nexus, but there are many areas that demand a connection.

JAMA concludes:

In a time-driven activity-based costing study in a large academic health care system with a certified EHR system, the estimated costs of billing and insurance-related activities ranged from $20 for a primary care visit to $215 for an inpatient surgical procedure. Knowledge of how specific billing and insurance-related activities contribute to administrative costs may help inform policy solutions to reduce these expenses.

 Overall this was a multi billion dollar expense, and its net result is more cost, reduced care, and increased overhead! Welcome to Government!

Cultural Exchange?

The Saudi Arab News reports on a cultural exchange with the Irish Embassy. They note that at an exchange where an Irish film was aired to a large Saudi audience:

These festivals attempt to educate Saudis about different cultures and promote exchanges between Saudi Arabia and European countries. The film was screened on a moonlit veranda, and attendees enjoyed the film as well as the nice breeze that filled the open space. “Waking Ned” introduces Saudis to two best friends, Jackie O’Shea, played by Ian Bannen, and Michael O’Sullivan, played by David Kelly, as they chance upon someone in their village who has won the lottery and they want in on the cash. When the lottery winner dies from shock, the entire village rounds up to convince an inspector that O’Sullivan is the deceased to split the reward. “We chose this movie, as opposed to last year’s horror film because we wanted to break routine. Everyone’s joining us after a long day at work and they just want to relax,” the office manager at the consulate, Rodaina Harb, told Arab News. “We wanted to display Irish culture, it’s beautiful music, the simplicity of their life, and to distinguish it, as most Saudis believe it to be a part of Britain, when it’s its own country. in fact,” she added. Fatima Mazin, a female in attendance told Arab News: “I thought the movie was hilarious, and the fact that the people put their wits together to fool someone and get that much money was very amusing.”

Now this is a bit of a strange cultural presentation. Humor can be a powerful tool if used properly. On the other hand one thing I learned is that one should never open a talk with a joke. They always backfire. And a movie about a dead winner and a couple of con artists is hardly a way to present a country. 

Friday, February 9, 2018

A Terrifying Chart

The chart above is the Treasury debt, marketable, by maturity. Recall from the previous chart that we have seen the short term rates explode. Then look at the above and see that most of the debt is short term and will be turning over but at higher interest rates! So 6 trillion at a 2% interest rate change is an interest increase of $120 billion. Just where is that in the Budget!

Interest and the Market

The yield curve shows two characteristics. First it is still flattening. Second it is rising.
The rise is worrisome but the lifting of the low rate is truly of concern. We have been presenting this for almost a year now. As the low end rises as rapidly as it does and as deficit increases as it is, then the cost of that debt, most of which is short term, explodes! The cycle becomes unstable.
The above is an example. We shall examine the FED balance sheet again as it unrolls debt, almost all worthless, and at the same time finances the excess. This could be a deadly embrace.

Thursday, February 1, 2018

MIT and Student Unions

The Tech, the MIT student paper, notes a positive response to unionizing graduate students. They note:

Another survey question asked respondents to select which union-related issues they would want to see addressed in a collective bargaining agreement. Salary, healthcare, and housing came out on top — 65 to 70 percent of all respondents selected them. Most other issues fell in the 40 to 50 percent range, with the exception of safety, which only 30 percent “gave a shit about,” the committee wrote in its email. The exploratory committee that organized the survey consists of four PhD students who hope to initiate dialogue around the issue of graduate student unionization at MIT, although they are not explicitly pro-union. They requested to remain anonymous, for fear that if they were seen as leaders of an unionization movement, they would be subjected to “undue scrutiny” from administrators and disapproval from their advisors.

As I had noted when Harvard started this process, this is very dangerous. Getting a PhD is often an individual process, an examination of the candidates qualities not some groups. Now the article also notes:

167 of the survey respondents self-identified as PhD students, and 38 self-identified as Master’s students. Undergraduates and other MIT affiliates were also able to respond, but graduate student data was extracted and analyzed separately. Respondents ranked their level of support for a potential MIT graduate student union on a scale of 1 (“definitely oppose”) to 7 (“definitely support”). Overall, PhD students averaged 4.86, while Master’s students averaged 5.29.

Thus of the near 5,000 grad students this sample is 200+ which are less than randomly selected. I won't belabor the statistics of selection but in what appears to be an ever growing group-think, proto-socialistic environment, MIT may place itself in a perilous position. Schools like MIT rely upon alumni and Government support. There may come a point when these actions become the "last straw" and result in financial collapse, and loss of academic rigor.

Monday, January 22, 2018

Scientific Snowflakes?

The Government is back in session. However The Scientist notes, or shall we say bemoans:

Nature spoke with crop researcher Chad Hayes at the US Department of Agriculture whose travel to Mexico today—timed to coincide with a brief window of sorghum pollination—could be disrupted, along with a year’s worth of work. According to Vox, half of the Department of Health and Human Services staff will not work during the shutdown. That means that, while the Centers for Disease Control and Prevention (CDC) will continue to monitor this year’s high flu activity, reports might take on a sluggish pace. “Under a shutdown, CDC’s capacity to track and respond to disease outbreaks will be impacted,” a CDC spokesperson tells Buzzfeed News. “Flu surveillance, for example, will continue to collect data being reported by states, hospitals, etc. However, our staff resources are limited, which means it will take longer to review, analyze, and report out information needed for public health action.”

You can't make this up! CDC closing? Hardly. It was at most a day off! Sorghum pollination? You miss a day of pollination and the world comes to an end! Guys, I spent all June, July, and August crossing plants. Have done it for three decades! Don't get paid! Is there some personal satisfaction in participating in sorghum pollination?

This is why we need some careful attention to our tax dollars and what they are spent for!