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.