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Thursday, May 28th, 2009
By John Whitesides
WASHINGTON (Reuters) - Congress has started work on a broad overhaul of the healthcare system in a rare spirit of optimism, but brewing battles over its cost, scope and structure could still scuttle hopes for a solution.
From President Barack Obama’s declaration that “the stars are aligned” on healthcare to a recent cost-cutting pledge by a half-dozen industry groups, momentum has built steadily on an issue that has eluded consensus for decades.
The first test comes in a few weeks when Congress unveils legislation, launching months of expected wrangling over the specifics of tax hikes, spending cuts and the government’s role in a revamp that could cost as much as $1.5 trillion.
“It’s true that the planets are aligned for healthcare as never before, but there are still big obstacles,” said Drew Altman, president of the Kaiser Family Foundation, a nonpartisan health policy group.
“We are about to enter a very different stage of the debate once everyone sees the specifics and how it will be paid for,” he said. “Getting a comprehensive agreement is a high hill to climb. We have failed many times.”
The push for reform is still haunted by the most spectacular of those failures, the collapse of the Hillary Clinton-led effort in 1994. But analysts say Obama so far has avoided some of the pitfalls that doomed that plan.
Obama has pursued a more open approach than Clinton in developing the legislation, which he hopes will curb costs and expand coverage to many of about 46 million uninsured Americans.
He asked congressional leaders to put together the bill, rather than presenting it to them as a finished package, and brought to the table many of the groups like insurers who helped kill the Clinton plan.
Congressional leaders have backed a quick timetable for approval, limiting time for opposition to mount. The first proposal will be unveiled in the next few weeks and Obama wants to sign a final bill before the end of the year.
‘TACTICALLY SUPERIOR’
“The whole approach has been eminently superior, tactically, to 1994,” said Ed Howard, executive vice president of the Alliance for Health Reform, a non-partisan health policy education group.
Obama has a strong political hand after a decisive White House win in November over Republican John McCain, and has large majorities of fellow Democrats in both houses of Congress to work with.
Obama and McCain backed dramatically different approaches to healthcare reform. But the issue rarely won the spotlight in a 2008 campaign dominated early by the debate over wars in Iraq and Afghanistan and late by the collapsing economy.
Since then, the economic pain of the recession has strengthened the drive for reform, spotlighting worries about spiraling costs and bolstering Obama’s argument that reform is vital to an economic cure.
“The status quo has been shown to be unsustainable right before our eyes,” said Len Nichols, director of the Health Policy program at the New America Foundation. “Healthcare is an economic issue again. How do you go out there and tell people we will not do anything about this?”
But economic concerns will fuel what is likely to be the biggest battle over the plan: How much will it cost and how is it paid for?
OPPOSITION EXPECTED
Lawmakers have floated a variety of possible tax proposals to help pay for covering the uninsured. Nearly any tax hike will run into opposition from interest groups, and many could drain public support.
“A lot of middle-income people who have insurance are probably going to read an article soon saying they are going to have to pay a lot more for this at a time when they are economically hurting,” said Bob Blendon, a health policy and political analysis professor at Harvard University.
“And they are going to say, ‘That’s not what I mean by health reform’,” he said.
Republican opponents have been slow to organize and uncertain how to proceed as they search for the proper way to frame their warnings that Obama’s approach could reduce choice and lead to a government-run healthcare system.
“We’re dealing with shadows. No one knows what is going to be in the bill so it’s impossible to assess,” said Gary Ferguson, a Republican pollster who specializes in healthcare.
The leader of the first organized campaign against the overhaul is Rick Scott, a multimillionaire ousted as head of the huge healthcare firm Columbia/HCA during a fraud investigation that eventually led to $1.7 billion in judgments against the company.
But the insurance industry, which helped kill the Clinton plan, could still spring to life if the legislation includes a public insurance plan favored by Obama and many Democrats that would help cover the uninsured and create competition for private insurers.
Opponents say it could drive companies out of business. But Blendon said given the economy, it will be easier to find a compromise on the issue of a public plan than on the money.
“Because of the problem of finding the money to pay for it, the bill could wind up being more modest in the beginning or it could be phased in over a longer period of time,” he said.
“There are so many options here. The one option Obama can’t accept is to go back to Democrats and say ‘I couldn’t get a bill passed.’”
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Wednesday, May 27th, 2009
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Tuesday, May 26th, 2009
  Articles are out this morning on Nancy-Ann DeParle and Peter Orszag, two major players on health reform for Obama, both of whom are working on issues that worry players in the industry.
Politico details Nancy-Ann DeParle’s focus on keeping the health-insurance industry’s messages in check as it pushes against Obama’s controversial idea of a public health-insurance plan. After the Washington Post ran a piece last week previewing Web videos that Blue Cross and Blue Shield of North Carolina was planning in opposition to a public plan — the storyboards include references to long waits and not being able to choose your doctor — DeParle called up the company’s CEO to talk him out of it.
“He said, ‘Well, Nancy-Ann, those aren’t ads. Those were just going to go up on a Web site,’” DeParle, head of the White House health-reform office, told Politico. “He’s not doing it now.” A spokesman for the company told Politico that it is a “proponent” of health reform and that its message on it will be “positive.”
Bloomberg, meanwhile, has an article on Orszag, emphasizing his the White House budget director’s focus on big variations in costs and quality in the health-care system. Orszag has perused the Dartmouth Atlas of Health Care, which chronicles huge variations across the country.
Orszag is a proponent of “comparative effectiveness,” comparing various treatments — an idea that the drug industry is largely resisting and that some doctors fear could force them to follow treatment rules.
“Huge efficiencies could be gained if we change the way we practice medicine,” Orszag tells Bloomberg. Underscoring how much money is at stake: When he headed the Congressional Budget Office in 2007 and 2008, he called it the “Congressional Health Office,” Bloomberg notes.
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Tuesday, May 26th, 2009
By Andy Sullivan
WASHINGTON (Reuters) - Countless workers in the United States are trapped in jobs they would like to leave because they cannot get health insurance elsewhere, calcifying innovation and mobility in the world’s largest economy.
Daunted by health-care costs, a would-be technology entrepreneur in Texas decides not to start her own business. A communications expert in Washington decides not to strike out on his own. And a freelance magazine editor in Brooklyn decides to take a less satisfying corporate job.
“I would rather be freelancing, no question,” said Jessica Tolliver, a former editor who now works in public relations. “I got my work done in less time, because once I finished what I had to do, the time was my own.”
Economists call this phenomenon “job lock,” and studies suggest that it keeps between 20 percent and 50 percent of workers from leaving their current jobs.
Because health insurance is tied to employment in the United States, workers who leave their jobs can see health bills skyrocket if they strike out on their own or take a position with a company that offers fewer benefits. Workers who would like to retire early stay on, unable to qualify for the government’s Medicare program until they turn 65.
And those who have existing health problems may not be able to get coverage at all.
Job lock is difficult to measure because many employees don’t like to advertise their unhappiness. But economists and small-business advocates say it takes an enormous toll on productivity.
SLOWING INNOVATION
“We can definitely say that it’s slowing down the rate of innovation,” said Tim Kane, an economist with the Kauffman Foundation which promoted entrepreneurship.
For Mike, a Washington-based communications professional who did not want to use his last name, health costs may force him to pass up the chance to be his own boss at a time when he could easily pick up several major clients.
With two children at home, Mike said he was reluctant to abandon the generous benefits he gets at the trade group where he currently works. Self-employment would probably mean spending more for fewer benefits.
“I don’t want a bad event to knock me and my family out of the box,” he said. “It’s a real hurdle.”
As head of the National Federation of Independent Businesses, Todd Stottlemeyer frequently encountered would-be entrepreneurs who let their ideas go stale and their products languish on the workbench because they did not want to shoulder their own health care costs.
When he asked audiences if health insurance has affected their employment decisions, often half the hands in the room would go up.
“There are lots of factors that go into why somebody starts a business or doesn’t start a business: Do I have a good idea, do I have capital, do I have risk tolerance?,” said Stottlemeyer, now an executive at a hospital chain. “Being able to get health insurance … should not be one of those determinant factors.” Continued…
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Wednesday, May 20th, 2009
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Tuesday, May 19th, 2009
WASHINGTON – David Blumenthal, MD, national coordinator for health IT, announced Friday the final members of the health IT policy committee established under the American Recovery and Reinvestment Act (ARRA). Besides Blumenthal himself, the other HHS appointees are: Michael J. Klag, MD, dean of Johns Hopkins Bloomberg School of Public Health; Deven C. McGraw. Health Privacy Project, Center for Democracy & Technology. Blumenthal will serve as chair.
The health IT policy committee has been waiting for members to be named by the Department of Health and Human Services Secretary Kathleen Sebelius, who was confirmed last week. The policy panel will meet for the first time on May 11 and the standards committee, also mandated under ARRA, on May 15. The groups will help HHS define meaningful use under the recovery act, with a definition expected in late spring or early summer, Blumenthal said.
The Office of the National Coordinator for Health Information Technology (ONC) is “totally focused” on President Obama’s initiatives to establish healthcare IT. Blumenthal said, on a conference call Friday. However, the bottom-line goal is not about health IT advancement, but rather improving patient care.
Under ARRA, an additional 13 members of the policy committee were appointed April 3 by Gene L. Dodaro, acting comptroller general. Four members are to be appointed by the majority and minority leaders of the Senate and the Speaker and minority leader of the House.
The Health IT policy committee will make recommendations to the national coordinator on a policy framework for a nationwide health information network, including standards for the secure and private exchange of patient medical information. The policy committee’s work will be similar to the former American Health Information Community (AHIC) and will recognize the work of that group and its successor, Blumenthal said.
Of the new panel, Blumenthal said, “it would be foolish to assemble a group of people with as wide and diverse experience as these people and not take their recommendations very seriously; and I will.”
Blumenthal said, he is confident that “these committees will provide valuable insight to help develop important health IT policy in the next few years.”
John Halamka, chairman of the Healthcare Information Technology Standards Panel (HITSP), told his members to nominate themselves in March for the new standards committee. AHIC 2.0, the private-public partnership known as the National eHealth Collaborative (NeHC), also advised its members to apply. The law specifies that the HHS secretary may select all of NeHC to be on the new standards committee.
Blumenthal said ONC is in discussions with NeHC and has not yet determined its role going forward.
Among the April 3 GAO appointees for the federal HIT advisory committee were Paul Tang, MD, chief medical information officer of the Palo Alto Medical Foundation in California, a member of the editorial board of Healthcare IT News, and Marc Probst, CIO of Intermountain Healthcare in Salt Lake City.
According to Dave Roberts, vice president of government relations for the Healthcare Information and Management Systems Society said applicants for the committee flooded in to the GAO and Capitol Hill.
According to ARRA, members of the HIT policy committee must represent “a balance among various sectors of the healthcare system so that no single sector unduly influences the recommendations of the policy committee.”
Also named to the Policy Committee were:
- David Bates
Brigham and Women’s Hospital
- Christine Bechtel
National Partnership for Women & Families
- Neil Calman
The Institute for Family Health
- Richard Chapman
Kindred Healthcare
- Adam Clark
Lance Armstrong Foundation
- Arthur Davidson
Denver Public Health Department
- Connie White Delaney
University of Minnesota/School of Nursing
- Paul Egerman
Businessman/Entrepreneur
- Judith Faulkner
Epic Systems Corporation
- Gayle Harrell
Former Florida State Legislator
- Charles Kennedy
WellPoint, Inc.
- Michael Klag
Johns Hopkins University, Bloomberg School of Public Health
- David Lansky
Pacific Business Group on Health
- Deven McGraw
Center for Democracy & Technology
- Frank Nemec
Gastroenterology Associates, Inc.
- Marc Probst
Intermountain Healthcare
- Latanya Sweeney
Carnegie Mellon University
- Paul Tang
Palo Alto Medical Foundation
- Scott White
1199 SEIU Training and Employment Fund
In addition, appointments were made to the HIT Standards Committee.
- Jonathan Perlin, MD, Chair
Healthcare Corporation of America
- John Halamka, MD. Co-Chair
Harvard Medical School
- Dixie Baker, PhD
Science Applications International Corporation
- Anne Castro
BlueCross BlueShield of South Carolina
- Christopher Chute, MD
Mayo Clinic College of Medicine
- Janet Corrigan, PhD
National Quality Forum
- John Derr, R.Ph.
Golden Living, LLC
- Linda Dillman
Wal-Mart Stores, Inc.
- James Ferguson
Kaiser Permanente
- Steven Findlay, MPH
Consumers Union
- Douglas Fridsma, MD, PhD
Arizona Biomedical Collaborataive 1
- C. Martin Harris, MD, MBA
Cleveland Clinic Foundation
- Stanley M. Huff, MD
Intermountain Healthcare
- Kevin Hutchinson
Prematics, Inc.
- Elizabeth O. Johnson, RN
Tenet Health
- John Klimek, R.Ph.
National Council for Prescription Drug Programs
- David McCallie, Jr., MD
Cerner Corporation
- Judy Murphy, RN
Aurora Health Care
- J. Marc Overhage, MD, PhD
Regenstrief Institute
- Gina Perez, MPA
Delaware Health Information Network
- Wes Rishel
Gartner, Inc.
- Sharon Terry, MA
Genetic Alliance
- James Walker, MD
Geisinger Health System
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Tuesday, May 19th, 2009
Posted by JHuntress
Summary: I took the next step with digital records by using the MediConnect service.
My foray into digital health records continues. Recently I paid MediConnect to aggregate my records from three different hosptials (childhood, college and current) and put them in a digital format that could be consumed by Google Health. Even then I’m sure I am missing about 25% of my overall records that are scattered at different hospitals. I also went in and filled out my profile on Google Health.
While many are concerned about privacy and certainly that is worrisome, I have the general feeling that not knowing my history (immunizations, shots, xrays, MRIs, blood work etc) is much worse so I’m taking some steps forward.
The Google Health service is linked to CVS, Walgreens, BC/BS and a couple dozen other providers with more being added all the time.
My feeling is that unless you havea great system for keeping and filing information you should at least consider this as something worth doing.
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Tuesday, May 19th, 2009
By Steve Lohr, New York Times
Some of the nation’s fine minds in medicine and technology have huddled, attended hearings and produced position papers in the last few weeks that focus on the definition of “meaningful use.”
The Obama administration’s health technology plan, which is part of the economic recovery package, includes incentive payments for adopting electronic health records — more than $40,000 per physician and up to several million dollars for hospitals. The payments are based on “meaningful use” of such records, although Congress left defining that term to the Department of Health and Human Services.
It may seem arcane and nit-picky, but how the government defines and measures meaningful use will determine whether the $19 billion in incentives is a significant step in reforming American health care or a high-tech fiasco.
The professional organization of people responsible for putting electronic health records to use, the Association of Medical Directors of Information Systems, is wading into the discussion on Tuesday with — appropriately enough — a Web site, www.meaningfuluse.org.
The public site is an aggregator of information and news on the developing debate over the best policy path for implementing electronic health records, and it also has forums for discussion. The consensus of the expert comments, said Dr. William F. Bria, president of the board of the association, will be conveyed to the Obama administration.
“It’s our fervent belief that the men and women who have implemented this technology in hospitals and clinics should be listened to and their advice incorporated in the national plan,” said Dr. Bria, who is chief medical information officer for the 20 Shriners Hospitals for Children in the United States. (The design and content of the site is controlled by the organization, but a partner company, Compuware, owns the Web site and is operating it.)
The danger, Dr. Bria said, would be if a well-intentioned policy is applied too rigidly and too quickly. That, he said, could well backfire, wasting money and undermining patient safety and the quality of care. There have been plenty of poor implementations of health information technology, as well as success stories.
ne thing that tends to be underestimated, Dr. Bria said, is the need for people who understand medicine and are technologically literate, to help tailor the technology for physician offices and hospital settings. “We’re going to have to have a whole new work force,” he said. “The idea that medicine can be perfectly standardized is not true — and shouldn’t be.”
The requirements for meaningful use, Dr. Bria said, should be graduated steps in a multiyear plan. Early ones, he suggested, might be using the electronic health records to measure and report vaccination rates, track and detect harmful medicine interactions, and check the percentage compliance of patients with wellness tests like cholesterol and breast mammography.
The key, Dr. Bria said, is to put American medicine on a path toward better health outcomes — “that’s the meaning in meaningful use,” he noted.
The approach Mr. Bria describes is broadly embraced by the expert groups that have weighed in already, including organizations like the Health Information and Management Systems Society and the Markle Foundation’s Connecting for Health .
The challenge for the Obama administration is going to extend beyond the detail-politics of experts in health care and technology suppliers, noted Dr. Blackford Middleton, a health technology expert at Partners Healthcare, a nonprofit medical group that includes Massachusetts General Hospital in Boston. For the debate on how health information technology is pursued is one part of a broader reform agenda sought by the administration, which includes broadening coverage, increasing access and controlling costs.
The administration’s health technology policy, Dr. Middleton said, is going to have to be politically as well as technically adept. The administration must have a draft of the meaningful use provisions ready by this summer, and, under the American Reinvestment and Recovery Act, they must be completed by the end of the year.
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Tuesday, May 19th, 2009
Forcing Google to delete user data after six months could dent its ability to predict pandemics such as swine flu, said the search giant’s co-founder.
Larry Page said he thought more debate was needed around the issue of storing user data.
The European Commission wants data ditched after six months but Mr Page said there were benefits to users.
“More dialogue is needed [with regulators],” he told UK journalists at a Google event in Hertfordshire.
Data clash
He said Google’s ability to plot and predict potential pandemics would not be possible if the firm had to delete search data after six months.
“When we released data about Mexico flu trends we had a whole debate,” he said.
“We were worried we would cause panic. But we decided the benefits outweighed the cost.”
Mr Page said deleting search data after six months was “in direct conflict” with being able to map pandemics.
In a demo to journalists, Google showed that it had been able to spot a potential pandemic ahead of government agencies because it was using search data.
On its website about spotting flu trends, the firm says: “Our up-to-date influenza estimates may enable public health officials and health professionals to better respond to seasonal epidemics and pandemics.”
Mr Page said the less data companies like Googe were able to hold the “more likely we all are to die”.
The European Commission has argued that holding on to search data runs the risk of third parties being able to build profiles of individuals even when some identifying information is deleted.
In September 2008, Google said it would anonymise data after nine months following pressure from Europe on the issue. Previously it had kept data, including IP addresses and search terms, for 18 months.
European advisers recommend that search engines should not keep data for more than six months.
Previously, Google argued that it had to keep data for longer to comply with requests for help from law enforcement agencies.
Tags: Digital Records, Electronic Medical Records, Google, Health Reforum
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Monday, May 18th, 2009
By Ina Fried, CNET News
In a win for Microsoft’s health care business, NewYork-Presbyterian Hospital said it will use the software maker’s technology as part of a push to make digital health records available to its patients.
The hospital system will start making health records available online, initially to cardiac and cardiothoracic patients. Customers can view their records online, opt to copy them into a personal health record and then, if they wish, share that record with other health care providers.
“These really are the patients’ records,” said Aurelia Boyer, a former practicing nurse, who now serves as NY Presbyterian’s CIO. “It is really their data. it is not the hospital’s.”
However, that’s a big shift for the industry, Boyer acknowledges. “Doctors and hospitals have kept those records sort of under lock and key.”
The deal also marks the first time that a Microsoft customer has gone with both its Amalga technology for managing the provider’s own records and at the same time tapped HealthVault to provide patient access. Microsoft launched HealthVault back in 2007 but said at the time it would need to line up health care providers to provide people with the impetus to sign up for an account.
The federal government has included billions of stimulus dollars to help spur the health care industry toward digital health records.
Google is also taking aim at the space and has partnered with IBM.
Last week, GE and Intel announced a $250 million joint effort in the digital health arena, with their effort heavily focused on helping people treating and living with chronic illnesses.
At NY Presbyterian, Boyer said that the hospital has put the infrastructure in place to handle large numbers of patients, but wants to start slow to make sure it has the human factors right–educating patients, making sure they know how to secure records, etc.
“We want to make sure we watch our process and we do it well with the patients,” she said. Digital heath records, she said, is a part of a broader effort to improve care using technology.
“We are attracted to empowering the patients, helping them move to health and managing their health and not just focusing on such a single episode of care,” Boyer said.
Opening back health records to the patient should also help the physicians who refer people in to hospitals such as NY Presbyterian.
“Now my referring physician, if giving right permissions, can look into my Amalga record,” said Steve Shihadeh, a vice president in Microsoft’s healthcare unit. “One of their big complaints is I send the patient in…and I don’t really know what has happened to my patient.”
Tags: digital medical records, Health Care Reform, Healthcare system, Microsoft Healthcare, New York Presbyterian Hospital
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