SGR Can Kicked Down the Road for Another Year With Bonus Item That Delays ICD10 Medical Coding Conversion Also For A Year, CMS Will Have More Time To Test And Debug

This is good news and bad news but the good news we’ll take right now as there won’t be any big administrative billing nightmares as have been experienced in the past.  After the CMS 10 day hold is when that would have kicked in and it is a mess.  So we can be happy about that and who knows when Congress might entertain hiring some Quants who can “model” the repeal of the SGR.  They might as well at some point start keeping up with the insurers who are hiring quants like I’ve never seen.  They are no longer just for Hedge Funds. 

It is pretty bad when that word “math” comes around with financial models and folks tend to run for the hills, but at least this time we didn’t have the usual default topic of Women’s Health run up the flag pole.  I have already kind of figured it out that when laws require a lot of math and financial calculations, they run over to talk abortions.  So again at least we were spared that show this year.  I did watch a few minutes of it and Senator Coburn made some good points about his disgust in not being able to fix the SGR. He got into the math and fake formulas and I like to see that addressed no matter who it is, but it all could not come together today.  That Plos One study is looking more accurate all the time as it states the fear of math gives people “real physical” pain:)

“Algo Duping” – PLOS One Journal Publication Explains Why The Fear of Math Plays a Big Role As One Underlying Reason We All Get Duped And Those Who Don’t Fear Math Take All the Money, Gradually, Using “Mathematical Formulas & Algorithms”

In addition some of the discussion rambled off topic a little bit, not bad stuff but things that need to be talked about too but maybe just not today. So they took the easy road and with the roll out of Healthcare.Gov delaying the ICD10 roll out was probably a no brainer as the Hill is probably not too high on the words “trust me” when it comes to technology decisions from HHS and CMS.  We still have that “Sebelius Syndrome” floating around. 

White House Names Former Microsoft Executive To Head Up Fixing “The Sebelius Syndrome” Plaguing What Ended Up On Healthcare.Gov

She’s not the only who has it either but got the name from so many public blunders when trying to talk about technology and got it somewhat humorously wrong so many times. 

Repeal and Replace Obamacare? Not Hardly From a Technological Standpoint As It Needs a Model-Nobody Wants to Swap Out Old Glitches For New Glitches: Modeling, Virtual Software Worlds and More Importantly Complex IT Infrastructure Reality, Get Hip…

The big thing is with ICD10 is have it work and have plenty of time to test and debug and debug and debug.  It was kind of nuts earlier this year when CMS was not going to test end to end and said the roll out date was firm, so yeah we heard that one before with Healthcare.Gov and there’s still issues.  This way too if there happens to be any code that has not been completed yet, they have time.  The ICD10 add on was not really discussed and was just put there so I don’t that was an issue with either side to agree on it.  Sure there has been a lot of money spent I recognize that but if a delay means better preparedness and roll out, so be it with the complex IT Infrastructures out there.  In the House we had this and tacked on 5 years for the insurance penalty of the ACA.  Who knows that could still happen somewhere else. 

ICD10 software and coding is nothing more than rolling out a whole new set of algorithms that have to play with the ones we currently have, its all computer code and data mechanics. 

House Passes Doctor SGR Bill With Conditions, Five Year Stall on Mandating Penalties For Individuals Not Buying Health Insurance - Why Not At Hold Off of Penalties (But Less Than Five Years) As Many Other Items In the ACA Are Getting Extended…

So why didn’t we do ICD10 when everyone had their data in silos (grin), I just had to say that:)  Long and short here the Hill just doesn’t want to do math and hire some Quants to model it for them.  Again I have beat the horse to death with so many posts about Congress getting that Office of Technology Assessment to help them with some of this.  It’s going to smack them in the face sooner or later as you can’t just focus on verbiage anymore, need to tie in the technology with some digital centric laws spelling a few things out. 

Medicare SGR Formula To Cut Medicare Payments to Doctors, When Will Congress, CMS, HHS And A Few Others Learn How To Model and Fix And/Or Replace It? This Is Math, Like The Quants Build All The Time At Banks, Hedge Funds And Insurance Companies..

Again I do have to say though that Tom Coburn was on the money today with addressing the fact that this has not been fixed and has needed a fix since 1999.  BD 

Meaningful Use Attestation

The CMS has extended the MU attestation deadline of the Medicare EHR incentive program for eligible professionals from February 28, 2014 to March31, 2014.

Meaningful Use Attestation

According to the health information technology, the meaningful use attestation is to document which an organization demonstrated the meaningful use and fulfilling the requirements for the EHR and related technology successfully.

Generally, the attestation is to validate about something which is true. The health care organization is supposed to demonstrate meaningful use to be eligible for payments under the Medicare or Medicaid EHR incentive program from the federal government. The list of electronic health record products have compiled by the Office of the National Coordinator for Health IT with the Center for Medicare and Medicaid EHR services used for meaningful use attestation under the program of CMS Medicaid and Medicare EHR incentive.

According to the HITECH act of 2009, organizations which are eligible for the Medicare EHR incentive program, should attest to the meaningful use by 2014 to be eligible for the incentive payments of EHR. The CMS and ONC have established all the criteria. The eligibility for the Medicaid program must have to demonstrate meaningful use by 2016 for the payment receiving.

It is beneficial to get started with the end result in mind when preparing for the meaningful use attestation.

Preparation and Planning for MU Attestation

·        Carefully go through the Meaningful Use requirements at the beginning of your attestation period and check it every after 30 days to keep away from the overlook anything

·        Always remember that the period of attestation is of 90 consecutive days

·        Always keep your stuff in a file folder with a backup hard copy.

·        Schedule to run the reports of meaningful use on a weekly basis for every eligible doctor

As the deadline of meaningful use attestation is extended till March 31, 2014, the providers got some more time to submit their meaningful use data to receive the incentive payment for the program year of 2013 plus to avoid the payment adjustment of 2015.

Attestation Procedure

There is an attestation and registration system for the eligible professionals to submit their meaningful use attestations. It is necessary to attest before March 31, 2014 to meet with the program deadline of 2013. The eligible hospitals must have to contact with CMS for assistance submitting their attestation.

Resources

There are resources available for the eligible professionals who are working on their attestation for the 2013 period.

·        Stage 1 meaningful use calculator

·        Website of EHR incentive program

·        User guide for the registration and attestation

Other than that, the information center of EHR is open for attestation with all the attestation and registration system inquiries.

Tips

There are also some tips which help the professionals keep their process easier for themselves.

·        Make sure that your relevant information is up to date in the Medicare payment system

·        Make sure that you have given the valid contact details in the registration of EHR program

·        Just sign up on attestation and registration system and make sure that you are provided information is correct and up to date and start entering your 2013 data

·        If you have any queries or facing problems, just call the EHR incentive program help desk or report the problem.

Luckily, the 2014 certified EHR will going to have a reporting system for everyone which will help them to keep reporting for every provider in their practice organized.

Healthcare.Gov Down For Extended Maintenance On Final Enrollment Day-Maintenance Algorithms Need Their Time As Complexities With IT Infrastructure Continue to Torment Deadlines Created By Humans…

Not the best time for extended maintenance to hit but what do you do? This is part of every major web service around but the timing could not be worse.  Hopefully it runs as needed and nothing out of the ordinary occurs to delay it even further.  I’ll say one thing, the government sure has learned a ton of lessons today when it comes to complex IT infrastructures. 

More and more us humans have to adjust to the algorithms’ schedules everywhere you turn.  So as what has been done before if you try to visit, you go to the virtual waiting room to wait.  BD 

Those Damn “Killer Algorithms” Keep Screwing Up Obamacare, One more Delay Added for Small Businesses, Static Text Laws and Digital Technology Crossing Hairs, We Continue To Endure the Constant Rise And Fall Of The Machines…

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(Reuters) - The website for people to enroll in U.S. private health insurance was unavailable early Monday morning, just hours before the deadline for the first wave of enrollment under the healthcare law.

Representatives for the Department of Health and Human Services, in a statement, confirmed the access problems to www.HealthCare.gov and said the website's usual maintenance time had been extended, but that the site was "coming back up."

http://in.reuters.com/article/2014/03/31/us-usa-healthcare-enrollment-idINBREA2U0QW20140331?feedType=RSS&feedName=health&utm_source=dlvr.it&utm_medium=twitter&dlvrit=309303

“Hospital Inequality” - Yet One More Growing Issue With Healthcare In the US..

Maybe this is something worth discussing as it certainly exists out there and since I cover many areas of healthcare, I’m seeing more and more of this with one hospital system doing very well, like UPMC, a non profit with a billion a year in excess revenue (that is profit talk for non profits) and then others struggling.  So much of the time we see news articles that state the ones having problems “don’t operate efficiently” and while there may be some truth to some of that, the divide here is growing all the time and that can’t be the only reason for the disparity.  Health IT can’t solve it all or even work at all in some areas to where the cards dealt vary so much.  Below you can read about the City of Pittsburgh suing UPMC as they could use some of that money.  Again you may have real estate that gets sold, you have to look at the demographic areas the hospitals serve and last but not least, reimbursement as that can be all over the place. 

Legal Battle With City of Pittsburgh and UPMC Medical Center Heating Up Again–Non Profit Hospital Pays No Property Taxes & Gets $200 Million Dollar Tax Break With $1 Billion in Excess Profits

Some hospitals have better assets to offset some of the reimbursement issues that are pretty much on the rise everywhere and sometimes I think some hospitals too get brow beaten over the fact that they can’t make money when in fact it’s the cards they were dealt to begin with.   Some may not have assets to fall back on and some don’t have money to keep up with enough IT investments and yet they are in the same CMS arena to perform the same with what they do.  Sure there are some adjustments out there and some of those help out for sure with non profits in particular but some get outdate too and as economic times change, they don’t work as well, or if the verbiage in the law gets interpreted with “selected context” some get windfalls too.  We don’t see the latter too often by comparison, but it’s out there.

Just yesterday I wrote about an abrupt close of a hospital in Massachusetts that closed on Friday and even the Governor was powerless to do a thing as they were flat out of money.  We they doing things so badly efficiency wise that they were a “bad hospital” without enough technology?  I don’t think so and again go back to the demographic areas they serve and look at the reimbursement issues the hospital was having. 

North Adams Hospital In Massachusetts Closes Abruptly on Friday, Out Of Money & Court Order To Stay Open Seems To Be Trumped By Lack of Money & Plan To Save The Hospital

Sometimes in the non profit areas you do see one hospital helping another and I go back a few years ago with Kaiser Permanente sending money to Grady Hospital in Atlanta, which was great but again they have to watch their own business and can’t be on the hook to save all hospitals either.  That was at a time when other hospitals in Atlanta said we would like to help but have our own problems. 

A couple months ago, 6 hospitals went up for sale here in California as they were out of money and it barely made the news.  Again are we going to do the same “shame” story here again and blame management for all of it when in fact there were many issues that lead to this?  It seems to be what you read anymore with folks searching for a simple reason for this re-occurrence that keeps happening?  It is time to stop to stop beating that drum and do some better in depth studies as to why this keeps repeating itself? 

Hospitals Feeling The ACA Crunch In California As Financially Strapped Daughters of Charity Health System Put Six Hospitals Up For Sale

Another contrast here in Los Angeles with Cedar Sinai, they seem to have quite a bit of money to keep up buying up physician practices as one doctor recently stated “they made me an offer I couldn’t refuse at it was that good”.  We know the reason for this type of activity comes back to reimbursement again as they can charge more to Medicare and some insurers when a patient is treated at a hospital owned facility and they are not by far the only hospital doing this.  The uneven levels of excess profits are not just limited to non profits either, here’s one example..

Hospital Profits and Revenue All Over the Place–Tenet Shows $28 Million While a Non Profit UPMC in Pennsylvania Has Excess Revenues of a Billion a Year & Hospital Revenue Cycling Subsidiaries Compete With Those Owned And Operated by Insurance Company Subsidiaries…

So this being said, we now have issues like this with either doctors or hospitals wanting to help patients with their insurance premiums and the logic behind this is not hard to figure out the ROI as if they help keep a patient insured it’s going to cut the losses the doctor or hospital has to absorb and the patient gets the care with reimbursement from the insurance company.  Sure I see the discussion here as to “which” patients will get this kind of help but I would rather see that and at least some patients get the care they need rather than it not take place. 

Hospitals Could End Up Paying Insurance Premiums With Consumer Policies Bought Through Exchanges If Patients Fall Under Major Income Stress Leading to Payment Default

As I have said, Obamacare and all of healthcare really for that matter is a big Attack of the Killer Algorithms..those damn algorithms can bring everything to a stop for sure until decisions are made about how they should work.

When Doctors Give Patients Money, Hospitals Pay Patient Insurance Premiums, Humans Helping Other Humans As The Attacks of the Killer Algorithms Grow Stronger Everyday While Gov Can’t or Won’t Model Or Wake Up For That Matter…

Now when this comes up for discussion we have the politicians getting involved with discussion that will probably just go nowhere for now at least.  With consolidation of hospitals today charges don’t seem to be going down at all and consumers with our inequality issues can bear the burden.  You can read the post below how the two individuals here who are largely both caught up in the Sebelius Syndrome overall are going to talk about this…so how do make a law on this topic?  That’s a really good question as you will end up denying care where it could be possible for patients. 

Senator Grassley and Kathleen Sebelius Duking It Out Over Hospitals Paying Patient Premiums–A Case of One “Who Believes In Algorithm Fairies” Talking To Another…

Long and short here is the failure of quite a few models here and why it is important to model in the hopes of catching a lot of unintended consequences before they occur and you will never catch all of them but if you see some ahead of time it does help.  Politicians tend to just suck in anything they read at times and we end up with quantitated justifications for things that are not true, and again this comes back to “those measurement” we see on hospitals all the time that are supposed to be care and safety related, but we certainly can’t fool ourselves and say that money has no part here, because it does. 

Quantitated Justification For Believing Things That Are Not True And Using Mathematical Processes To Fool Ourselves-The Journalistic Bot Functionality Debuts As Media Can’t Resist the Formulas

So there you go perhaps a new topic to begin giving attention, “Inequality for Hospitals” as it does exist and how long before we really start taking a look?  So far inequality for consumers has been talked about but that’s about it as politicians refuse or lack the intelligence to see how all of this is modeled.  It’s all math models and subsequent algorithmic processes running on servers 24/7 whether it’s consumers or hospitals that keep the inequality movement growing sadly. 

You can explore more of this in the financial world here with a collection of links and videos that talk about Algo Duping and the Attacks of the Killer Algorithms provided by people smarter than me that have taken time for several years now to educate and give the warning and when politicians decide to come into the “real” world from their virtual perceptions, who knows.  That is also a big problem as well as I recently discussed that topic at the link below too.   

Virtual Worlds, Real World We Have A Problem And It’s A Big One With A Lot of Gray Areas Finding Where The Defining Lines Exist, Confusing Many With A Lot of Weird Values And Strange Perceptions…

Inequality is all “modeled” using a lot of segmentation in short…watch video # 3 in footer for more on this topic.  BD

Modeling for Inequality With Segmentation, Insurance Industry Uses Backwards Segmentation As Some Models Stand to Threaten Overall Democracy

Protein Principles for Diabetes | Accretive Health

Dietary concerns will gift a option in polygenic disease. Even once the intake is wholesome, assimilative it are often another matter. Then there's the matter of progression of diabetic complications if one finally ends up with excess aldohexose or fat within the system. Excess carbohydrates during a meal, and also the ensuing uncontrolled glucose levels are often damaging to any variety of tissues, from the lens of the attention, to the neurons, tiny blood vessels and also the kidneys. Fat is additionally a retardant with increase incidences of coronary-artery disease, giant vessel sickness and internal organ complications. What, then is that the applicable macronutrient for the diabetic population? Enough medical literature exists to recommend that in polygenic disease, proteins square measure most likely the simplest bet.

Proteins square measure the natural selection of the body once visaged with polygenic disease. In uncontrolled polygenic disease, muscle macromolecule is weakened into amino acids to be born-again into aldohexose by the liver. If left to argue itself, this may produce a commotion among the body. Since proteins ought to offer enough energy to substitute for carbohydrates, proteins square measure weakened quicker than they're created. The body finally ends up with a macromolecule deficit, a state of affairs with refined, nonetheless extensive effects on traditional body functions. significantly, for diabetics, a macromolecule deficit has been shown to impair resistance to infections (Ganong WF). Replenishing the depleting macromolecule stores may be a important demand of all diabetic diets.

Importance of proteins during a diabetic has been well documented. The yankee Associations of Clinical Endocrinologists have created it clear that not a lot of proof exists to point that the patients with polygenic disease have to be compelled to scale back their intake of dietary proteins. The AACE recommends that 10-20% of the calorie intake in polygenic disease ought to return from proteins (AACE polygenic disease Guidelines). it's in truth believed that this is often one nutrient that doesn't increase glucose levels in each diabetics and healthy subjects (Gannon et al).

Nutrition medical aid for polygenic disease has progressed from interference of avoirdupois or weight gain to up insulin's effectiveness and causative to improved metabolic management (Franz MJ). during this new role, a high macromolecule diet (30% of total food energy) forms a awfully pertinent a part of nutrition medical aid. one in all the foremost necessary causes for sort II polygenic disease is avoirdupois. Excess body fat raises internal secretion resistance and better levels of internal secretion square measure needed to bring down blood sugars because the weight will increase (Ganong WF). Another drawback with excess fat is that the preventive of arteries with arteriosclerosis plaques that's answerable for a large vary of diabetic complications. Any mechanism that reduces body fat decreases internal secretion resistance and improves glucose management. Parker et al have additionally shown that a high macromolecule diet cut abdominal and total fat mass in girls with sort II polygenic disease. different studies by Gannon et al. and Nuttall et al have verified that glucose levels and glycosylated hemoprotein (a marker of future diabetic control) scale back when five weeks on a diet containing half-hour of the whole food energy within the variety of proteins and low saccharide content. it's speculated that a high macromolecule diet features a favorable impact in polygenic disease because of the power of proteins and amino acids to stimulate internal secretion unleash from the exocrine gland. Thus, a high macromolecule diet isn't solely safe in polygenic disease, however may also be therapeutic, leading to improved glycemic management, and cut risk of complications associated with polygenic disease.

The benefits of a high macromolecule diet don't finish here. Individual macromolecule elements of such a diet, once competently chosen, will produce other blessings yet. Dietary supplements containing proteins like whey and casein return extremely counseled. Casein may be a milk macromolecule and has the power to make a gel or clot within the abdomen. the power to make this clot makes it terribly economical in nutrient offer. The clot is in a position to produce a sustained, slow unleash of amino acids into the blood stream, typically lasting for many hours (Boirie et al. 1997). A slow sustained unleash of nutrients matches well with the restricted quantity of internal secretion which will be made by the exocrine gland in polygenic disease. A macromolecule supplement containing casein will therefore increase the number of energy assimilated from each meal and, at constant time, scale back the necessity for medical specialty interventions to manage glucose.

Whey proteins and caseins additionally contain "casokinins" and "lactokinins', (FitzGerald) that are found to decrease each pulsation and pulse force per unit area in hypertensive humans (Seppo). additionally, whey macromolecule forms bioactive paraffin within the gut that promotes immunity. Whey macromolecule contains AN ample offer of the organic compound aminoalkanoic acid. aminoalkanoic acid seems to reinforce glutathione levels, that has been shown to possess robust inhibitor properties -- antioxidants mop up free radicals that induce death and play a task in aging. Thus, development of a macromolecule supplement containing casein ANd whey will offer an apt high macromolecule diet and its health advantages to people full of polygenic disease, avoirdupois and symptom.

North Adams Hospital In Massachusetts Closes Abruptly on Friday, Out Of Money & Court Order To Stay Open Seems To Be Trumped By Lack of Money & Plan To Save The Hospital

The hospital had emerged from bankruptcy a couple years ago and it appears that money could not be made here due to the fact that a big percentage of the payments come from Medicare.  The compensates the hospital with 66 cents for every dollar spent so there’s the gap.  The hospital relies on Medicaid funding.  The state has underpaid for years so again we have hospitals like UMPC making a billion in excess profits for a non profit and then we have one like this that can’t keep their doors open.  Profits and losses for hospitals are all over the books. 

The state audited their books after bankruptcy. Fund would be available if the state declares the hospital a “critical care” facility but the hospital has to be 25 miles away from the next nearest acute center care hospital, and it is 23 miles so someone has to change a law I guess.  Just a few days prior the Governor said the hospital should survive.  500 jobs were lost.  Makes politicians look useless when the money’s gone.  On Tuesday the hospital officials said it would close on Friday and that it did.  Northern Berkshire Healthcare is the parent company of the hospital.  BD

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NORTH ADAMS, Mass. (WWLP) – Questions that many people in Berkshire County are asking include how did the hospital get into this financial crisis? Can anything be done to get out of it?

North Adams Regional Hospital filed for bankruptcy back in 2011 and their finances were audited by the attorney general’s office. The state may have contributed to the root of their financial issues.

SEIU Union Spokesperson Jeff Hall told 22News that 46% of the hospitals patients were on Medicare and that the state only reimburses the hospital about 66-cents for every dollar of care provided, leaving the hospital with a gap that can be filled only through donations.

http://wwlp.com/2014/03/28/why-is-north-adams-regional-hospital-closing/

Maryland Ready to Drop the “Crappy Code” And Start All Over With Another Contractor For Their State Health Exchange, Sounds Like Even QSSI Doesn’t Want To Mess With It Either..

Sometimes that happens to where no matter what you do with an engineered system, if too much of of the coding uses doesn’t work well then you could be wasting a lot of time trying to fix it.  Sometimes it may be just a module that you can re-write and replace to work with the other modules but from what I am reading here it might be past the point of return here if this is the latest decision, plus fixing it might be more expensive too than a total new system and you still have some corrupt floating around even after a repair.  You can read below where the subsidiary of United Healthcare was called in to see what they could do. 

Maryland State Insurance Exchange Brings In United Healthcare Subsidiary QSSI To Help Repair The System, Their Main Contractor Is Also Owned By Insurance Company, Insurers Have Truckloads of Subsidiary Companies You May Not Be Aware Of

If perhaps the model used in Connecticut is similar enough to where it can work with the needs of the state of Maryland, perhaps it could be used.  Each state model was different and had different contractors and some same and some different technologies used.  Deloitte is the one being called in to fix this one and they have had some bad situations too so there’s big hero contractor that can fix all. 

In Depth Story of the Maryland Insurance Exchange & How It Failed, Sebelius Syndrome Existed Here Too-Government Digital IT Illiteracy And Politics Just Don’t Mix Well..

This would be the first state to chuck it with the entire system, although we know, but nobody has told us officially that there are parts of Healthcare.Gov that were re-written modules too.  That’s just how it works.  If nothing else, folks are finding out how complex IT infrastructures are today and you just run it up the flagpole and give a due date and expect everything to be fine.  The federal program is still having issues with code working with other code and I said the other day that pretty much all of healthcare is just a bunch of algorithms that won’t or can’t work together.  In saying that too, we also add in politics and other situations that make it difficult as folks don’t seem to realize that you can work forever on the verbiage of laws, but the code running on servers 24/7 is what executes. 

The fear of acknowledging this fact was pretty clear a couple years ago when the director of HHS, came out and gave a talk that said “hurry it up”:)  It kind of has some satire and humor to it in the fact that most of the time developers and those writing code are working at 150% anyway so add that novice perception into the batch and the technologists just look at who’s talking and say “huh”…or they get aggravated at the level of digital illiteracy when such speeches are made to the public with politicians with a bunch of bees in her bonnet basically with the fear of this real issue making her look bad, but nothing you can do about it. 

Speed Up Rate of Change in Health IT?–“Short Order Code Kitchen Burned Down a Few Years Ago and There Was No Fire Sale”..IT Infrastructure Chance and Revisions Takes a Lot of ”Code”, “Time” and “ Most Importantly Money”

Here too this “audit” is yet another weird perception as how many experts does the OIG have to accomplish this with the Feds, and last I looked the White House when the site failed had to go searching for them, but that’s the weird and kind of goofy stuff you hear from folks with zero data mechanics knowledge or experience and they try to either explain or do a CYA.

Sebelius Asks Inspector General To Review Healthcare.Gov, How Many JBoss, Red Hat, Linux, Oracle, MarkLogic And Other Experts Does OIG Have? Time Elements of Baking A Cake From Scratch With Writing Custom Code Was Just Not There..

The exchange in Maryland has worked but again if they are ready to chuck it, well that tends to say there’s some truckloads of bad code still hanging around that’s not worth fixing.  It’s like buying a house that is in really bad need of repair with everything run down and not working versus leveling it and starting over.  Same thing works for code and get the right algorithms to work.  BD 

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Maryland officials are set to replace the state’s online health-insurance exchange with technology from Connecticut’s insurance marketplace, according to two people familiar with the decision, an acknowledgment that a system that has cost at least $125.5 million is broken beyond repair.

The board of the Maryland exchange plans to vote on the change Tuesday, the day after the end of the first enrollment period for the state’s residents under the 2010 Affordable Care Act.

But unlike Maryland, where the system crashed within moments of launching and has limped along ever since, Connecticut’s exchange has worked as smoothly as any in the country.

Maryland is not alone in having deep-seated problems with its health marketplace. Technical issues also have plagued Oregon, Minnesota and Hawaii. But Maryland will be the first to walk away from its site, a particular embarrassment for Lt. Gov. Anthony G. Brown (D), who was placed in charged of implementing health-care reform in Maryland by Gov. Martin O’Malley (D).

Henry said the exchange has cost $125.5 million to develop and operate.

As of last Saturday, 49,293 Maryland residents had enrolled in a private plan through the exchange, far short of the state’s original goal of 150,000 enrollments and shy even of its revised estimate of 75,000 to 100,000.

http://www.washingtonpost.com/local/maryland-set-to-abandon-troubled-health-exchangeadopt-connecticuts-system/2014/03/28/ef6a3a3e-b6d2-11e3-8cc3-d4bf596577eb_story.html

Virtual Worlds, Real World We Have A Problem And It’s A Big One With A Lot of Gray Areas Finding Where The Defining Lines Exist, Confusing Many With A Lot of Weird Values And Strange Perceptions…

This unwelcomed phenomena that exists today…”The Grays”….

Well somebody had to say it and sure we are experiencing the return of virtual reality which there’s nothing wrong with it for gaming or viewing let’s say a movie or just a more vivid experience.  When virtual reality first came out, well it was pretty definitive as everyone knew the game plan.  You check in and become someone you want to be in a virtual world and play around, have some fun, meet some other virtual people and hopefully when you are done you return back to your normal “real world” self.  Some people really got into and a few even got into a little trouble a few years back with getting confused but those were kind of isolated cases.  Again everyone understood that when you checked in to your virtual world it was just that, virtual.

Well let’s move forward a few years and look at where things have gone.  Technology is moving via leaps and bounds and just two years ago we didn’t have what we have today.  Two years ago some of the technologies we have out there today were not even thought of yet.  There’s more elements out there today with virtual reality to mix with and unfortunately it’s getting folks confused with where values are.  I have made the comments that if I had to choose between being connected to Facebook or using a Bill Gates toilet, well the real world tells me I need a toilet first if you will:) 

We see stock values way over inflated on what we place on virtual technologies.  When you take social networks, for the most part, what do you have?  You have a bunch of apps that connect you to something or someone and it’s all code, data and queries stored on servers.  No tangibles here to speak of other than the cost of the hardware and yet we see stocks go way out of line here.  Sure there’s value but not to the levels of what we are seeing.  Come on, huge stock price values and IPOs on data and apps sitting on servers somewhere?  They are intangibles and they are out of balance with the values placed on the “real world”.  We need both, and boy am I seeing some very confused folks out there any more. 

Data has value, no doubt but you are marketed as well and and your value as a human compared to an algorithm, well it’s not very good.  With complexities today and marketing, watch people on a dating site.  It’s like going into a store with way too many decisions and then you are given more opportunities for some “click bait” to view even more and the site makes money as you move through a series of pages through ad exposure.  You have some very smart mathematicians that know how to work you and keep you coming back.  In other words don’t find your match, just keep coming back as the site will entertain you and keep you convinced that you need it.   This is another form of the “gray” areas as meeting someone online is hard enough as you meet them a fraction at a time.  So add on all the other money making noise and they got you. 

It was kind of funny today that I read an article that Google is doing to do a study “to learn how people work” so is that ironic?  They seem to hire quite of them and after how many years in business they don’t know how people work?  I read another article that said employees at Google can’t separate their work from their personal lives..hmmm..a little gray here too?  It’s kind of funny they need a study as we all kind of know, and self included you have to shut it for a few hours, days, etc. to get your feet totally back in the real world. 

Heck even last year the Algorithms were not educated enough at Google and said I was a real duck and suspended me as the machines did not recognize it as a surname, that worked everywhere else in the world and I had to deal with the virtual Google Plus world and substantiate that I was “real”.  In the virtual world I could not exist there without a “machine compliant” name.  See how the virtual world messed with me and next time it could be something serious like a credit report or background virtual issue, as flawed data is on the rise due to the current data selling epidemic we have. 

“I’m Sorry Your Google Plus Name Does Not Comply With Google “Names Policies”…Barbara “Duck Algorithm” & Was Using My Real Name All Along…Killer Algorithms Chapter 52

I keep talking about one topic over and over too and that is “people don’t work that way” and I reference that when I keep reading about how developers and companies in the mHealth business can’t hook the consumers.  There’s a few reason besides just not wanting to be involved and that includes the data selling aspect as we all pretty much know it’s double sword and there’s the danger of some of your information getting out there and being used out of context.  You know with data and what  ever context you decide to apply, you can make a person look like a hero or a zero, only the query monster knows for sure. 

This strangeness has even spread to TED, and if this happens I’m done with TED:)  It’s an X-Prize (AI X-Prize) to do a Ted presentation with artificial intelligence.  I agree again with Larry Ellison (more below) who’s business is technology that people are more interested in people.  Sure the virtuals are not going away but with what I see and the gray areas growing, do we need to create bigger gray areas.  So what’s next, quantified virtual worlds? 

I have never seen a time when people jump all over statistics like magpies.  I’m not saying they are all bad by any means, but anymore it’s like the peanut gallery that jumps up and rolls off numbers over and over.  A Los Angeles Time writer recently commented on that too saying “consumer are drowning in data” and we are.  I see it and get tired of it, so add on a bunch of magpie type repeats and it’s like “gosh how do I get away from some of this”:)  I like to read studies and statistics but I don’t want to be drowning in them with maximum doses in my face all the time.  Some of the studies and articles are just pure bunk too.  We end up with way too much quantitated justifications for things that are not true, usually because someone is trying to sell something.  Now I’m not saying it’s all bunk because it is not but it gets mixed in with the good stuff, and duped you are. 

Here we go again with the “gray” areas that constitute a lot of confusion with folks not knowing where’s the real and virtual worlds, and where you draw the line?   If you like this clip below then venture down to the footer and watch the entire video #1, it’s one of the best out there to make this point.  What did I read and is that credible?  A question that’s worth a mention today before you suck in everything as some is good and some is marketing. 

Press releases though are usually a good spot to place statistics and that’s respectable as you can link what the “sell” aspect is with the studies or stats mentioned, but when we get these wild statistic news stories that are not attached, what is their point you do have to wonder? 

Larry Ellison gave some really good feedback, kind off the cuff in his lecture given at his HCM conference.  He’s very disturbed with kids that are just spending their time on video games, so we go back to the virtual worlds again.  Go to the end at the Q and A for his “personal” comments at the link below. 

Larry Ellison, CEO Oracle, HCM Conference Keynote–”Be Careful About Virtual Relationships With Artificially Intelligent Pieces of Software That’s Smarter Than You“, It’s Really All About People”–Algo Duping and the Killer Algorithms Living Amongst Us…(Update) Video

He’s says there’s a virtual ball instead of a real ball with games and everyone gets to be LeBron with virtual reality.  Kids are confused he says, everyone thinks they are LeBron. If your game playing or life is more fun in the virtual world, it’s a danger.  Virtual relationships..again we go back to dating sites.  The impact of technology on children right now he says is both fabulous and terrible. 

In the end Ellison says, we are really more interested in people even with our interest in technology and I think he’s right on that and there’s a bit of rub as some of that is being lost with the pace we have with technology today.  We can’t slow technology down but we can control the rate at which we absorb it personally.  We can’t control though how it evolves around us and it confuses people.  What’s real and what’s virtual?  

Again go hang around a dating site and you see all these areas to click and read and look at pictures and then are presented with more, or there’s little amusements there to ask a person to upload more pictures, and that will keep you busy if you want to appease all of the requests:)  The sites can keep you very busy and you can lose your focus as why you are there.  The funniest one was a site that sends you a flow sheet to visualize it for you, again the interactions until you move off the site and meet someone in person, it’s all virtual.  I sit there and kind of laugh at some of that as if want to know me better, then talk rather than give me some kind of virtual busy work to do:)  It’s how you get sucked in.  If a person loaded up fake pictures, then they’ll probably load up some more fake pictures for you:)

The movie HER, and really all you need to see is the trailer and you can get the message on how this guy substituted a real relationship with a virtual one that made him happy, so there we go with some of those “gray” areas.  This is worth embedding the trailer here again to make the point.  Sometimes folks don’t even realize they are just living for this bit of attention on the web and then lose touch with what’s real out there.

Movie “HER”– Good Example On How Folks Can’t Separate And/Or Unite The Virtual With The Real World, Billionaires Are Made Out of Those Who Know How to Keep These Areas “Gray” With Creating and Maintaining The Addictive Code That Does It…

If you go back a few months you can also read where Bill Gates said “the internet will not save the world” so again maturity here with technology and where it can really benefit.  Both Bill Gates and Larry Ellison were the early pioneers and understand “data mechanics” better than anyone else out there and again have the maturity to see beyond the end of their nose by all means and we should listen to both of them. 

So again virtual reality has it’s place but when the lines get gray that help you determine where the virtual worlds leave off and where the real world kicks back in, it gets pretty fuzzy out there.  I run into people all the time with what I call weird or strange perceptions as they carry some of this over into the real world and there are companies that profit richly from it, so be careful.

HER Movie

And here’s one more clip..Mike Osinski “with software you can do something about everything” but you have to live in the real world and he knows a bit about virtual worlds as he wrote the software all the banks used for the mortgage scam that banks used improperly and drug so many of us into a virtual world.  The big refinance was all mastered and created in a “virtual world”.  So keep that thought if you will. 

The whole country was sucked into that virtual world where banks did real stock transactions where the sales and models were not representative of the real world, (I’d call it virtual risk at this point) but hopefully we are little smarter now.  If you like the clip then go down to the footer and watch video #2, the Quants of Wall Street to learn more about how that virtual world functioned.  As Larry Ellison said on his HCM talk, we though we were Lebron.  This video was made about 3 years ago, so not new knowledge here at all. 

So with all the tech insanity we seem to be experiencing of late, well time to keep it in check and allow consumers time to digest some of it and not “dummy down” folks for profit either. 

This video from Dr. Sean Gourley, physicist and CEO of QUID might make you think a little bit.  He tells us last year 51% of the traffic on the internet were bots, the rest humans.  Last year it's up to 61% bots and the rest humans, so what's going on here.  He uses a chart to show the human value with the value of the bot, and it's doing better than human value.

Dr.  Gourley states we do need algorithms to manage the complex world, but who's algorithms are they, and will I benefit one could ask as well.  We know in this process that bot are going to get more access for sure and the human access looks like it will dwarf that.  So again trying to look and dig deep, there's some good questions or things to think about here for sure. 

So who's going to be the biggest benefactor here?  Is the next number going to be stating 71% of the internet is bots and the rest humans, so what is the real function to connect Facebook with drones?  Who’s going to really benefit?  A lot of bots and the company that owns them and makes money from them…bots are worth about $100 and humans are worth zero and are basically tech slaves.  Sure some folks will get internet connectivity and that’s not a bad thing but at a cost and it will support the growing world of bots and their profitability not the humans as we become what Dr. Gourley states, the techno slaves that only fill in where the bots can’t go. 

“Generation Like”, the Relentless Marketing of Teenagers Online and The Money It Makes, “Fake Like Farms” and The Money Generated There As Well..(Videos)

Anyway I hope I made the point here about the growing “gray” areas we have with virtual technologies and be aware as you might accidentally find yourself subscribing to the virtual values and losing some of your own “real world values”.  All those new folks getting access will be able to be LeBron too.  The essay below is great and worth reading, be a skeptic when you need to be and you might ask is it real or is it virtual sometimes to help keep your balance, I do it:)  I want to be aware and cognizant of when thing venture out of the virtual world and have impact on what’s going on in my real world, the one that really counts.    Talking with quants and mathematicians who design and model a lot of the virtual worlds out there can be big help too as t

“On Being a Data skeptic- Modelers Have A Bigger Responsibility Now Than Ever Before”–A Must Read Essay, Start “Sniffing the Data”…