Ran across this piece at Economic Policy Journal. Disturbing how bogged down our doctors will get in the future.
Dr. Mark Sklar writes:
The push to use electronic medical records has had more than financial costs. Although it is convenient to have patient records accessible on the Internet, the data processing involved has been extremely time consuming—a sentiment echoed by most of my colleagues. To save time, I was advised by a consultant to enter data into the electronic record during the office visit. When I tried this I found that typing in the data was disruptive to the patient visit. My eyes were focused on the keyboard and the lack of direct contact kept patients from opening up and discussing their medical and personal problems. I soon returned to my old method of dictating notes and pasting a print-out of the dictation into the electronic record.
Yet to avoid future financial penalties from Medicare, I must demonstrate “meaningful use” of the electronic record. This involves documenting that I covered a checklist of items during the office visit, so I spend 90 minutes each day entering mostly meaningless data. This is time better spent calling patients to answer questions or keeping updated with the medical literature…
To prevent physicians from prescribing more costly medications and tests on patients, insurers are increasingly requiring physicians to obtain pre-authorizations. This involves calling a telephone number, often being rerouted several times and then waiting on hold for a representative. The process is demeaning and can take 30-45 minutes…
To avoid Medicare penalties, I also must participate in the Physician Quality Reporting System program. Initially, this involved choosing three codes during the patient visit to reflect quality of care, such as blood pressure or blood-sugar control, and reporting them to Medicare. In 2015, the requirement will increase to nine codes.
Coming down the pike, but thankfully postponed from the October 2014 deadline, is something called ICD-10. This is a newer system that will contain about 70,000 medical diagnostic codes used for billing insurance. The present ICD-9 system has about 15,000 codes. The Physician Quality Reporting System and ICD-10 requirements are intended to benefit population research, but the effect is to turn physicians into adjuncts of the Census Bureau who spend time searching for codes—and to further decrease the amount of direct contact with patients.
The practice of medicine in the current environment is unsustainable. The multiple bureaucratic distractions in my day consume so much time that I have to give up what little personal time I have in the morning, evening and on weekends if I want to continue to provide excellent care during office hours.
In 1984 the RCA Dome opened for business its primary tenant was the Indianapolis Colts. The total cost to complete the RCA Dome was $77.5 Million($176.5 Million in present day inflation adjusted pricing). The cost was financed by the taxpayers of Indianapolis($47.2 million worth of bonds) and The Lilly Endowment/The Krannert Charitable Trust($30 Million). In 2006 the city undertook building a new stadium where the Colts presently play today. In 2006 the total outstanding debt on principal still stood at $75 Million and scheduled to be paid off by 2021. Before 2006, the actual debt was supposed to be paid off by 2013, but through refinancing of bonds, it jumped to 2021.
The city of Indianapolis does its best to make access in researching debt it owes on things tedious to find. The most current numbers I could find were published in 2010 showing RCA Dome debt standing at $61 Million. With eleven years of payments left comes to about $5.5 Million in annual payments on an already demolished structure.
Investors make a lot of money off local governments through time in financing these short term adventures that politicians want. Lucas Oil Stadium where the Colts presently play was built for $700 Million along with their new $275 Million Convention Center. This was financed over thirty years and once interest/financing charges are factored in, the combined project will cost taxpayers about $1.8 billion.
Cold air has rushed into America for the month of September. Below is what NOAA reported today and click on link for map of records
NOAA – 246 Low Max Records Broken or Tied From Sept 1 to Sept 10. Some records broken by 16F
Washington DC political reporter Jamie Dupree released the current financials of the Untied States Government:
Budget deficit in August was $128.7 billion; total deficit so far this fiscal year is $589 billion
Current government debt is
$17,764,720,406,589.08
Obtained some pricing from a person involved with livestock being brought in and sold at a stockyard in eastern Indiana.
Last week top grade cattle were getting $1.50/lb when brought in for sale. Just six years ago same person said going price was around .50/lb.
Stocking up on meat this winter would not be a bad idea.
Last year Indiana lawmakers relaxed some rules in allowing investors and alcohol makers open up distillery operations to make whiskey. Now some operations have popped up and the specialized business of the alcohol industry will have to wait and see how it all plays out financially.
Here is how the alcohol rules got relaxed
They pointed to states such as Michigan, where 32 small distillers sell local spirits and generate tourism dollars and tax revenue. Kentucky’s “Bourbon Trail” attracts 400,000 visitors to distilleries, which buy more than 2 million bushels of Indiana corn, each year.
The law that went into effect in July 2013 allows an artisan distiller to produce no more than 10,000 gallons of liquor for retail sale a year. The distiller cannot sell spirits to a retailer or a dealer but must sell by the drink, bottle or case on the premises.
Unlike big craft-spirit operations that buy liquor from wholesalers then flavor, bottle and label it as their own, the products of Indiana’s artisan distilleries must be homegrown. At least 60 percent of the final product must be fermented and distilled from raw materials on-site.
So far five permits have been granted and seven more are awaiting approval. The investors must also already have a federal permit for the process. Investments into the operations can run as high as $500,000.
The most important thing to remember of this new business venture for Indiana alcohol consumers, the bourbon and whiskey are still aging. Only when the first batches are tasted will indicate success of this new expansion.
Hat Tip Indiana Economic Digest
Saudi Arabia has recently announced a very aggressive plan to start introducing nuclear power plants and big solar farms into their power supply grid to replace hyrdrocarbons. I find it insane the U.S. does not pursue nuclear energy in all forms. It would stabilize the entire country and be a source of power for decades to come. Here is the entire article but will pass along the highlights.
The Saudi Royal Family hopes that nuclear will provide 15% of the Kingdom’s power (18 GWe) within 20 years, together with a similar 15% (40 GWe) from solar. They are planning to invest $80 billion to build over a dozen nuclear power plants as fast as possible, intending for the first reactor to come online in only eight years. Investment in solar for the same energy production will take about $240 billion in investment, although breakthrough technologies in the next decade should cut that cost in half.
Total electricity consumption in Saudi Arabia exceeds 200 billion kWhs per year and is expected to double by 2030
Two largest uses of power in the Middle East are for desalinating seawater and residential cooling. Saudi Arabia desalinates over 250 billion gallons of seawater each year, and that number will double in the next ten years as the population and industrialization increase.
Saudi Arabia burns almost a billion barrels of oil a year to produce electricity
Saudi’s neighbor, Abu Dhabi in the United Arab Emirates started towards the solar/nuclear combination as well. Here is an interesting note to show how much solar it takes to equal nuclear power
Recently the UAE opened what was, at the time, the largest solar plant in the world, the 100 MW Shams 1 at a cost of about $600 million. But two hundred Shams 1 arrays will be needed to equal the output of the four Barakah nuclear reactors.
Several times during the last few months while listening to sports talk radio I would hear the claim that “400 golf courses are closing yearly in America”. This went along with the theme that golf participation is declining and younger Americans are not joining clubs while current members are getting too old for the game. This peaked my interest because the claim of 400 a year is a lot of golf courses. So I decided to research it and find out what was happening. Bloomberg News had a nice write up back in January of this year and here is what they found:
More golf courses closed than opened in the U.S. in 2013 for the eighth straight year, according to the National Golf Foundation.
A total of 14 18-hole courses opened last year, up from 13.5 in 2012, while 157.5 courses were closed during the year, three more than a year earlier, the Jupiter, Florida-based organization said in a statement on its website. The organization counts every nine holes as 0.5 of a course.
Since 2006, course closings have outnumbered openings after more than 4,500 courses had opened over the previous 15 years. Those courses, many of which were built as part of real estate projects, shut down as the U.S. recession led to a reduction in home sales needed to support the courses. Golf club memberships and rounds played also declined during the recession.
Of the closings, 66 percent charged less than $40 for greens fees during peak times. The closings decreased the total number of U.S. golf courses to 14,564.5, the Foundation said. Public courses made up 97 percent (151.5) of the closures, with private courses accounting for 4 percent (6). A total of 8.5 public courses opened last year, compared with 5.5 new private courses.
Since 2006, 643 18-hole courses have closed, the organization said. The decline has followed a 40 percent growth from 1986 through 2005, a period with more than 4,500 courses opening, according the foundation data.
So while golf courses are closing, not at the exent the ESPN radio host is making it out to be.
Month of August Interest on Debt payment was $27,093,517,258.24. Fiscal YTD payments now stand at $411,217,855,816.94. There is one fiscal month left for 2014.
Soure: Twitter page @USGovtInterest
Hoosier Econ 