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Comment: Re:Conspiracy! (Score 4, Funny) 659

by sgent (#43120437) Attached to: Most Doctors Don't Think Patients Need Full Access To Med Records

That's not what the book says...

1) Quoting directly from the manual... "When Counseling and/or coordination of care dominates (more than 50%) the physician / patient... encounter, then time may be considered...

2) The actual code 99215 (level 5 existing patient office visit" reads "Physician's *typically* spend 40 minutes face-to-face". That statement only is applicable if #1 above applies. If not "...requires 2 of three key components". Typical doesn't mean every visit. Also I quoted the 5 minute visit for a level 4 visit. In a stable diabetic, treating a skin infection (for instance) may only take 5 minutes, which is enough time for a detailed history of the illness and the medical decision making which is of moderate complexity -- thus its a 99214 if all the physician does is write an antibiotic script.

Medicare alone has about 250 pages on how to code an E&M (office) visit, from two separate policy manuals, and most insurance companies (every one I've ever dealt with) use Medicare's definition. The CPT manuals I've looked at usually just barely touch the surface of the full regulations.

Comment: Re:Conspiracy! (Score 1) 659

by sgent (#43120039) Attached to: Most Doctors Don't Think Patients Need Full Access To Med Records

With the exceptions of psychiatrists and some relatively rare situations (direct management of a code, etc.), doctor's rarely bill on time -- and are usually not allowed to.

They bill on a combination of three items -- history taken (or updated from last visit), medical complexity of the visit, and the physical exam done. For new patients the level of visit is based on the least comprehensive of those three items. For existing patients its based on the middle of the three.

Its entirely possible to bill a legitimate level 4 visit (on a scale from 1-5) for a patient with diabetes (for instance) during a 5 minute visit. There are "time" codes listed in the coding manuals, but their use is restricted to when doctors are primary providing counseling (diet and exercise, etc.) during a visit.

+ - Bill Would Require Patent Trolls to Pay Legal Costs->

Submitted by sgent
sgent (874402) writes "Rep. Trent Franks (R) has introduce a bill which would require a loser pays system for patent trolls. It would only require loser pays for companies which aren't actively producing their own technology, and is only effective for hardware and software patents. Apparently it faces little opposition, and hopefully this congress will pass it."
Link to Original Source

Comment: Re:Dr. Higgs himself said it best... (Score 1) 396

by sgent (#40540993) Attached to: LHC Discovers New Particle That Looks Like the Higgs Boson

Greatest discovery in physics....

I'd put the mapping of the Human Genome (2003), or creating new organs from stem cells (2008), or Synthetic Biology creating a cell with a fully artificial genome (2010) all up there as well. Don't forget faster than light neutrino's (confirmed a second time), or a vaccine for HIV. That's in the last 10 years, much less 20.

Comment: Re:Because both of those solutions (Score 1) 245

by sgent (#39869225) Attached to: Google Apps Beats Office 365 For US Dept. of the Interior Contract

I've worked in both -- including a stint as a full time job in creating / working with dashboards and report generation in Cognos, etc. for an insurance company with 5000+ employees. We still had to pay IT via interdepartmental billing.

There are some things that RDMS's are just bad at. If I need to generate reversing entries and allocations to close out a month, a RDMS is slow and not very capable -- and Excel is great at it. I would still upload the final product to the database at the end of the day. If I had to write software to do the same, it would take much longer -- especially since much of the business logic changed every month. It would of been possible, and maybe an enterprise with 100,000 users instead of 5,000 may have found it worthwhile, but it would have taken years to break-even vs. using excel.

There is no question that these desktop solutions *sometimes* outgrow their original tools (ie enterprises dependent on a single spreadsheet) -- and that maybe happening in the grandparent, but for every 1 of those that IT sees, there are 50 or more of those that plug along and do their job reasonably well -- and only require 1 hour of an accountant's time, vs 100 hours of programming time (probably 30% of that is due to accountants explaining and detailing what has to be done). Accountant's jobs cannot always be broken down into easily generated programming logic -- even for relatively repetitive tasks like basic taxes or multi-jurisdictional reporting.

This still doesn't address things like data analysis. Sure a stored procedure can generate what you need, but that requires a higher level of expertise and a lot more time in many cases. If I want to perform a T-Test or statistical analysis beyond the basics, do something like a median (I just had this problem), do advanced graphing, etc. Many / most of the database and reporting tools are inferior to Excel and F9.

Comment: Re:Security (Score 1) 245

by sgent (#39868625) Attached to: Google Apps Beats Office 365 For US Dept. of the Interior Contract

Department of Interior has multiple police agencies (National Park Rangers, etc.). They also have access to things like medical records from the Indian Health Service, etc. They also deal with items such as business plans, etc. which are not subject to FOIA and contain proprietary information.

That being said, I don't have a problem with cloud services. No one has convinced me why Google or Microsoft is a less safe place to store data than my IT department. In many cases (although given enterprises maybe the exception), those two entities have much more experience than most companies in running a datacenter. Its their core business, its not the interior departments of joe blow's widget manufacturer.

Comment: Because both of those solutions (Score 1) 245

by sgent (#39868505) Attached to: Google Apps Beats Office 365 For US Dept. of the Interior Contract

*may* suck in the real world for a variety of reasons.

For X amount of data (less than a few million rows), excel is a perfectly adequate flat file database if don't need a relational database -- and many items don't. This isn't VisiCalc anymore on computers with 640k of memory.

Ajax? REALLY???? Most people I know who use Excel heavily are not programmers -- they are accountants. I know of about 1 in 50 accountants have any idea what the hell Ajax is, much less any ability to do anything with it. Why should I pay an IT consultant / IT department 1000's when I can do something that meets my needs in 10 minutes.

I'll grant that Access *might be* a better solution, but depending on analysis and presentation needs it may not be -- or again it may require programming in VBA or 10's of hours of work to get what you need.

Databases suck at analysis. SQL based crosstabs can be useful, but they also have major limitations if you are not going to drop to a programming language. God forbid you try something like finding a median of a dataset. Instead of =Median(data), its a 100 lines of code.

For smaller datasets Excel is a much better solution in many / most cases than a database solution if you don't need the relational mechanisms, joins, etc. -- which 90% of spreadsheets don't.

Libre Office's spreadsheet sucks. They cannot even get basic UI functionality that has been in all spreadsheets since VisiCalc, much less come close to the quality of Quattro of 15 years ago.

Comment: Re:Not really complex - HA HA HA (Score 1) 229

by sgent (#39574353) Attached to: Federal Court Tosses Colorado's Amazon Tax

Ok, let's say I'm not amazon, I'm a small tractor supply store in MN. I sell a lawn tractor to a MS resident. Problem is, there are 3 different taxes for "lawn tractors" depending on various factors. If I'm Home Depot I've hired a lawyer to figure this out, but lawn company in MN can't do that for every one they sell. MS by the way is a comparatively easy state to collect in.

Now, think of a state like Louisiana. The state, parish, every town, and often other political entities (special taxation districts) all can level sales taxes. So you can have a different tax rate in the same town and zip code by crossing a street. On top of that, every jurisdiction exempts different items or taxes them at different rates. How the hell is someone in California supposed to figure this out? On top of that, I'm supposed to file separately with every entity I'm subject to taxation from, so one sale could easily land me with 3-4 tax returns to complete. Oh yea, and if I sell that tractor to a farmer the thing maybe exempt, but I still have to file on their specific paperwork, etc.

The reasonable way to do this (and I'm not opposed) is for the states to simplify the collections. This could be accomplished in many ways -- for instance an interstate compact or federal law. However, states need to have a uniform rate within their jurisdiction, uniform exemption standards (at least from the merchants perspective) and all states need the same definitions as to what is taxable. They also need to allow for proxies to file / pay the tax. Then a merchant would be responsible for knowing 1 set of rules, and submitting up to 50 returns -- which they could do through a proxy (for instance if I'm a small seller I can send my sales records to salestaxcompliance.com and they will take care of the filing paperwork, etc.).

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