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Anyone who reads my blog learns that word, algorithms which sometimes I refer to as the "A" word.  I am striving to let people know how they are written and how they work, behind the scenes of all we hear on the news, as people can say anything they want, but until the code and queries are altered, nothing happens.  Below is the link I posted to my blog and I just want people to know how formulas work and what they do as the entire world is wrapped around these decision making algorithms and we need balance when it comes to human lives.

I will try to update on this forum and later will include another diary on how profits are made with doctor referral websites and how inaccurate that data is as well, as I found my own deceased doctor still listed and she has been deceased for over 7 years.  Stay tuned on that one as the consumers are not getting accurate information and companies are making big profits doing this.  Again, I'm new at this forum and I hope I am making some contributions of value here.  

This is an update from MSNBC on the Arizona Budget cuts.  There are 2 cases here to where both patients need transplants but can’t get them due to the laws passed by the legislature and signed by the governor, the Arizona Access plan.  Lucky both men are in fair condition but can’t last that long.  We have seen the breast cancer algorithm and again companies forget that there are people attached to these numbers.  The governor will not call a special session and there are 98 others in the same situation as the people shown in this video.  Below is the post from earlier this week.  Arizona Access had 2 companies provide them with statistics to make these decision on transplants.  See how powerful these algorithms are that compile data are and they don’t contain ethics issues.

I have been talking about this for 2 years about how the formulas are being used against those who do not understand the calculations.  There's a lawsuit the AMA settled on short payments made by United due to the algorithms created to short pay out of network charges that was brought about by Andrew Cuomo of New York.  When you dive in deeper here, they also sold and licensed these "algorithms" to other insurance companies to base their out of network payments so you had Blue Cross, Health Net, Aetna and others all using the same formulas so they made money from other insurance companies too for the use of the formulas.  There are lawsuits all over the country on the use of the out of network data base that was used.  I update them as I can.  I have over 3 years running on specific posts on this topic.  

Keith Olbermann talks about the fact that the studies said bone marrow transplants never work and that liver transplants rarely work.  He also brings up that doctors kicked in with some statistics on this that 42% work.  October 1st was the day that all these cuts went into place.  A new roof is being funded for the Coliseum in Phoenix but these folks can’t get their transplants to save their lives.  The governor refuses to use stimulus money to fill the gap on the funding.  What is a life worth one has to ask and is this going to continue?  It’s the power of those algorithms that run on servers 24/7 and the people that allow these mathematical formulas to make those decisions.  Here’s a good book worth reading for all of those that think the formulas are all creating accurate results.  They also create desired results and as you can hear from the video, accurate and desired may not be the same.

When Sicko came out, the algorithms were shown with the woman that was denied claim coverage on failing to report a yeast infection she had many years ago, these are algorithms run to analyze and find this data to look for what has been coined "fraud" but there are false positives that result.  That situation could have happened to anyone, but what we have here is the fact that "we have the data" and the consumer doesn't have it, and thus so it is used against people when data can be construed to show something that anyone could have easily forgotten and when it hits the news everyone wonders how did this happen, it's the data they have on file and interpreted to either deny coverage and/or claims.  There has to be some balance here as when we go back and have data that is in our files that doctors and health organizations have entered (again we don't do that as consumers) there is room for questions and of course there's errors in that data too.  With data entry by humans, there's always errors and that's all of us as we are human and make errors so the integrity of what is on file is again an area to question.  

Many years ago before preventive healthcare was deemed necessary to cover, doctors would write up a statement and bill for a disease a patient didn't have in order to get the co-pay and coverage for a physical for example.  If a physical way back was listed, the patient had to pay for all of it, so thus a diagnosis was entered that was maybe not the truth, i.e. a well woman visit back then may have been written up as a yeast infection.  Today it's different but this is worth a mention as this data is still out there and being analyzed and used for criteria from years ago, so again when old data with human input is looked at, one has to ask how much of this is out there and I would guess there's a lot of it.  This is something to be aware of as again as patients we need to line up data to go to battle as some of this may appear and be used with determining how claims are paid.  It's all about the data and the algorithms today and more importantly how they are interpreted when it comes to the care we need.  

Originally posted to medicalquack on Sat Nov 20, 2010 at 10:20 AM PST.

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Comment Preferences

  •  Also it's (2+ / 0-)
    Recommended by:
    Coilette, whoknu

    (Warm and fuzzy, huh?)
    Not "Access", which would just be irony poisoning in this case.

    "You have three friends in your life: God, your Mama, and the Democratic Party. And I'm not so sure about your Mama." --Alan Grayson

    by chicating on Sat Nov 20, 2010 at 10:28:12 AM PST

  •  Thank you. (1+ / 0-)
    Recommended by:

    This is something that we should all know about and fight against.  Having been in medicine for years, it never ceases to amaze me what the insurance companies can come up with to deny claims.

  •  T and R'd (1+ / 0-)
    Recommended by:

    Because United's selling of the algorithms IMJ is one of the most important things we need to know, to push back against the 'repeal' crowd.

    "I'm a chunky broad in a wheelchair! What on earth do I have to lose by speaking my mind about politics?" Me.

    by imfunnytoo on Sat Nov 20, 2010 at 10:32:37 AM PST

  •  I've been at this too long (0+ / 0-)

    I knew I'd been spending way too much time at the computer when I started swearing at an algorithm—in a solitaire game!

    These are a few of my favorite things.

    by JG in MD on Sat Nov 20, 2010 at 10:53:50 AM PST

  •  United to market you at CES show too (0+ / 0-)

    Well if you are planning a trip to CES to check out gadgets and technology, a new partner there too, United as they are all out marketing and collecting data.  See their China investments too.

    Today, you need to be aware of the subsidiaries that companies own and what they are doing with them, super business intelligence with combing, mining, and analyzing data.  Everything may not always be as it seems on the outside and algorithms for profit are definitely built in, and at what human cost?  

  •  Malign computing is subverting (0+ / 0-)

    I don't want to believe you about the formulas and algorithms but I know you're right and they're pervasive. Computers are being used to translate real life into perverse formulas by people in power who have no one's best interests at heart in mind but their own.

    The more we all live in the computer world, no matter how benignly, the farther we get from the real world in ways we don't even know about. There are adults who have lived half and half in real and computer worlds for so long you they don't even know how it feels to be IRL 100% of the time.

    Not just our paradigm but our brain function is being altered. Most people don't even know what a paradigm is, much less that they live in one like a fish lives in water. Brain function + paradigm = human experience.

    I'm often accused of thinking too much, and probably I'm being too fearful. I don't know.

    These are a few of my favorite things.

    by JG in MD on Sat Nov 20, 2010 at 11:24:31 AM PST

    •  Oncology algoirthms -pay for performance (1+ / 0-)
      Recommended by:
      JG in MD

      Thank you for your comments.  Sometimes I have folks get mad at me for bringing the picture to the front and I don't like what's going on either and didn't write nor interpret these algorithms, but am more or less trying to be a town crier of sorts.  

      The next use of formulas has to do with oncology with insurers trying to keep the cost down and United has a pay for performance program pilot to pay oncologists for saving money and hearing that should almost make one's hair stand on end, it did mine.

      They also purchased a company in China this year that promotes more Chinese drugs and medical devices globally and in the US and already has an open line of communication with the FDA.

      The fix here of course should go back to the cost of the drug to be within budget tolerances and not put the responsibility on the doctors who want to choose the best drug for the patient and with pay for performance, you know what could be at stake.  Drug prices need to be affordable all the way around.

      Also in the news this week, Bayer with layoffs and hiring more in China with employees finding out via a press release before an internal notice was sent out.

      It's all pretty crappy but a sad reality and like everyone else the big profiteers of big business I think will eventually have to reduce their pricing and profit expectations too.  Those algorithms have rearranged our entire financial picture here in the US and it took a few years to do it with financial algorithmic formulas on Wall Street.  

      I really wonder how much longer some of the big companies can continue to buy up others and consolidate data for profit and maintain those big profit levels, especially when it is completely fouling up how we get healthcare in the US.  

  •  Repuglycans MURDER to save MONEY! (0+ / 0-)

    They are murdering the soul of this nation. And the fact that no one raised this issue during the elections is a clear indication that the people of this nation are numbed by the amount of death we see everyday both here and abroad. And when they look to their leaders for guidance, those same leaders tell them it is okay to kill one's neighbors in order to save money. SO, in TX they have real, operating DEATH PANELS and in AZ they have condemned nearly 100 people awaiting transplants to death to save money. Capital punishment for the CRIME OF BEING POOR!! The repuglycans lied us into two wars, to torture on the world stage and now kill our own to satisfy the god of MONEY. Satan must be laughing his ass off!!

  •  To donate to (0+ / 0-)

    either men mentioned on Countdown: Francisco Felix go here:
    and Randy Shepherd:
    to donate to anyone in need of a transplant:

    "My case is alter'd, I must work for my living." Moll Cut-Purse, The Roaring Girl - 1612, England's First Actress

    by theRoaringGirl on Sat Nov 20, 2010 at 01:05:21 PM PST

  •  On one level (0+ / 0-)
    the question ought to be, how much is it worth to save a life? Because there are lots and lots of illnesses that are much cheaper to treat than transplants, and poor people are dying from them left and right. Saying that there is no amount too much to pay to provide a transplant, but then ignoring those with conditions that are relatively cheap to treat and stabilize is not really a solution to the problem. It is a very expensive band aid.

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