Subtext: In the DC panel debate on the Role of “Data Liberacion” Executive Chairman of Abraxis Health, Patrick Soon-Shiong, commented on how coordination and exchange of health data can improve healthcare and have a direct impact on individuals. He also talked about how his “realizing of the American Dream” enabled him to contributes to this through the non-profit organization the Health Transformation Institute.
Today was a big day in health care information technology (HIT). There are so many acronyms in HIT that I probably should publish a list, not today though. The Office of the National Coordinator of HIT (ONC) of the Department of Health and Human Services (HHS) issued its final rule on meaningful use criteria. As we know, these are the requirements that ‘providers’ (mainly physicians) have to meet to receive incentive payments from the Centers for Medicare & Medicaid Services (CMS) for the use of electronic health records (EHR) and other specific information technology (such as electronic ordering, electronic prescribing & exchanging of health information). The incentive payments start as early as this year for Medicaid providers, the rub is that after 2015, if you haven’t qualified, you will receive smaller Medicare or Medicaid payments (you can only qualify for one). These criteria were first published early last year & have been in comment periods or under revision ever since.
Despite this long period of evolution (over 2000 comments were evaluated), the question for providers continues to be “Is it worth it to me or my practice to even try to qualify?” The incentives are supposed to be based on the cost to acquire & adopt the necessary technology, but the total incentive (paid over as much as five years) is well under $100K for Medicaid providers. This may be close to the actual cost of the technology, but that does not take into account the disruption in practice caused by training, workflow changes & differences in usage caused by the technology. Providers who have been used to talking to their patients (even in the small amounts of time that modern clinical workflows allow) must now also do data entry (into the EHR) & spend part of their time filling out electronic order & prescription forms. This disrupts the clinical visit for both the provider & the patient. I have had not a few people (it’s people who are patients after all) tell me that they refuse to allow their doctor to enter data & consult “the computer” during their visit. They feel it’s disrespectful, regardless of how productive it may potentially be.
The long anticipated final rule on Meaningful Use was unveiled yesterday with much pomp and circumstance in a rather unusual ceremony which, interestingly, also marked the first public appearance of Dr. Berwick as CMS Administrator. The Final Rule is contained in an 846 page document. Accompanying the CMS ruling is the 228 pages final EHR certification rule issued simultaneously by ONC. Fortunately for all of us scrambling to figure out what has changed, Dr. Blumenthal released a synopsis in NEJM (recommended). Already many articles and dissertations have appeared and indubitably many, many more will be written in the next few days and weeks analyzing every change and every nuance of the new, and now binding, Meaningful Use. For those who don’t care much about nuances, preferring a bigger and lower resolution picture, here are the major changes to the old version of Meaningful Use.
By far the biggest relaxation was to divide the original 25 measures (23 for hospitals) into two groups – 15 mandatory measures and 10 optional measures of which only 5 need to be fulfilled, per provider choice. This is in effect a 20% reduction of the Meaningful Use burden.
They added back a requirement for hospitals to record advanced directives. It is listed in the optional group, which means that some hospitals could choose not to implement it, but one must be grateful for having it back on the list.Continue reading…
In this part of the panel debate on the Role in a World of “Data Liberacion” founder of Chordoma Foundation Josh Sommer tells the story about how he was diagnosed with Chordoma and how he funded the Chordoma Foundation with his mother as a reaction to the lack of treatments available. Josh is working to help coordinate data sharing between different researchers.
More than a year or so of squabbling is (sort of) over and today HHS announced its criteria for the first phase of meaningful use. Essentially the 25 criteria for qualifying for “meaningful use” (in other words who qualifies for the money) have been changed to 15 with a further 5 from a menu of 10. The details are here, and it looks like most of the percentages needed to qualify have been relaxed but not eliminated. The Dogs have clearly had a minor victory in that there are patient communication requirements in both the mandatory and optional criteria.
The most impressive part of the announcement (you can see it here) which included HHS Sec Sebelius, CMS head Berwick (not wearing his Che Guevara T Shirt) & ONC Director Blumenthal, was the two Reginas. First, Surgeon General Regina Benjamin explained how thrice her clinic was destroyed by nature, and how the second time she realized that while she had thought she couldn’t afford electronic records for her patients, she then realized that she couldn’t afford not to have them.
The other Regina was our friend Regina Holiday who made (to me) a surprise appearance and told the 73 Cents story in a heartfelt and powerful way. She’s really become the poster child for why access to health data matters to ordinary people, and we need to get her from the world of webinars, Health 2.0 Conferences and HHS announcements onto Oprah and the 6 O’Clock News right now.
And I’ll be suggesting that when I interview David Blumenthal in a little under 30 minutes.
What is the important thing Don Berwick could do as head of CMS to improve quality and reduce the cost of health care? Let’s face it, as head of a humongous agency, it is hard to make changes. You have to pick your battles carefully, for every cause has a constituency and an opponent. Gridlock is a fact of life in Washington, DC: The system is designed for that result.
Let’s just say, though, that you had a chance to adopt one innovative regulation or proposal, one where even opponents would have little moral ground on which to get traction.
Announce that you are going to create a website in which each hospital is invited to input two or three real-time metrics with regard to reducing harm. Let’s start with central line infections. There is a common definition provided by the CDC. Many hospitals keep track of their rate of infection.
Provide a password-protected template and give each hospital CEO (yes,
CEO!) the opportunity to send in his or her hospital’s quarterly figure
for the world to see. Set up the web page so the accumulated sequence
of numbers is translated in a trend line, so anyone can watch a given
hospital’s progress over time.
SUBTEXT: Jamie Heywood, Co-Founder and Chairman of PatientsLikeMe, spoke at the recent Health 2.0 DC conference. While on stage, Heywood issued a challenge to federal agencies to "change what we pay for."
Let’s do a thought experiment. Suppose you were a U.S. Senator and the President’s nominee to head CMS appeared at his confirmation hearing:
Wearing a Che Guevera t-shirt, sporting the image of a psychopath who apparently enjoyed killing people, or
Fondly clutching a copy of Quotations from Chairman Mao, written by a man who presided over the genocidal murder of more people than any other person in the history of the world.
When I was at Columbia University, my fellow students did these sorts of things. I soon learned they were not evil. They simply could not think clearly about moral issues involving collectivism. I view Don Berwick in much the same way.
President Obama took advantage of a short Congressional recess to appoint him to run Medicare and Medicaid without even a hearing. Although the President blamed Republicans, even some Democrats were unhappy with his snubbing of normal Senate prerogatives — something Obama criticized George Bush for doing with the appointment of John Bolton as UN Ambassador.
A few weeks back we welcomed John Goodman as a contributor at THCB. His first column was more than a tad critical of me for impugning the ethics of Harvard Business School Prof Regina Herzlinger. Herzlinger, you may recall made a boatload of money off her position on the board of directors of Wellcare. Wellcare was operating a Medicaid and Medicare HMO in Florida, while basically using that not-too-sacred trust as an excuse to defraud the taxpayer.
Due to the demands of reality cutting into my work-life, my blow-by-blow analysis of Wellcare’s bad behavior has waned a little, but here I instead commend to you the consistently great work of Roy Poses over at Health Care Renewal. Earlier this month Roy took a look at the latest chapter in the tawdry tale. I encourage you to read his article for the full tale, but essentially even despite the settling of the criminal and civil charges for theft of around $46m, there’s a brand new set of charges from the same period—this time theft is alleged of up to $600 million. This new set of allegations were collected by (FBI informant & Wellcare financial analyst) Sean Hellein who wore a wire for more than a year, and probably stands to make a packet in the qui tam suit.
And not that I’d further besmirch the reputation of Prof. Herzlinger, but the time period all this happened was while she was still on the board, and none of these were given as her expressed reasons for leaving. Then it struck me, is Regi in on the qui tam suit too? That would be the way to make serious money out of her insider knowledge.