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Month: April 2011

Personal Health Records: Will Doctors Connect?

• 4

By JANE SARASOHN-KAHN

What doctors are most likely to use patients’ personal electronic health records? Fewer than 1 in 2 are willing to. Those who most likely would include Hispanic physicians, doctors who practice in rural areas, those employed in hospitals, and surgeons.

As part of the HITECH Act included in the American Recovery and Reinvestment Act (ARRA) 0f 2009, U.S. physicians have the opportunity to receive a portion of the $20.8 billion carved out as incentive payments to those who adopt and “meaningfully use” electronic health records (EHRs).

Many EHRs include portals which allow patients to access a slice of their personal health information. Some patients create their own personal health records that might be as simple as an Excel spreadsheet or as robust as Kaiser Permanente’s My Health Manager or the VA’s MyHealtheVet.

The format of the personal health record (PHR) aside, researchers from the AMA, University of Chicago and the Markle Foundation wondered how willing physicians would be to use patients’ PHRs. The results of their survey are published in the February 2011 issue of Health Affairs.

The bottom line is that physicians’ willingness to connect with patients’ PHRs varies by the doctor’s gender, clinical specialty, race, geographic location, size of the practice, and whether they are already using an EHR. The chart details these findings by physician characteristic.

The physicians who would least likely embrace patients’ would most likely practice in suburban geographies, in solo or duo practices, be female, and be in primary care or pediatrics. And those who don’t use an EHR currently are much less likely to be unwilling to use a patient PHR.Continue reading…

Health 2.0 Show TODAY

Don’t forget that there’s a Health 2.0 Show, our free online hour long show at 10 PST/1pm EST. Today (Thursday). Register here for FREE.

We’ll be taking a look back at some highlights from the Health 2.0 Spring Fling, and have brought back some live product demos:

IOM Health Data Initiative Forum is June 9

Health 2.0 is supporting and I’m attending The Health Data Initiative Forum on June 9, 2011 at the National Institutes of Health in Bethesda, MD, and you should too. The Forum aims to accelerate momentum for the public use of data and innovation to improve health as part of The Health Data Initiative, a collaborative project of the Institute of Medicine and the Department of Health and Human Services.  The Forum will feature more than 45 fast-paced demonstrations of cutting-edge health apps that developed using health data, a series of panel discussion sessions on important health topics, and a data and apps expo.  You’ll be able to interact with developers, as well as investors, venture capitalists, and federal, state and local government officials. A provisional agenda is available online.  Space is limited and the registration is filling up fast!  Take a moment to register today, and let me know if you have any questions….and yes this was written by an IOM PR person not me, but it’s all true!

Unlucky Student

• 28

By KIMBERLY SEELYE

Last
 July,
 I
 found
 myself
 needing
 to
 visit
 a
 doctor
 for
 an
 urgent
 medical
 issue.
 My
 period
 had
 started
 in
 April
 and
 never
 stopped.
 It
 was
 light,
 so
 it
 wasn’t
 too
 much
 of
 an
 annoyance, 
but 
after 
three 
months 
I 
figured
 I
 needed 
professional 
help.

I
 had
 started
 graduate
 school
 in
 Michigan
 the
 year
 before
 and
 was
 back
 home
 in
 California
 for
 the
 summer.
 I
 wasn’t
 sure
 if
 the
 new
 insurance
 that
 I
 paid
 over
 $2,000
 per
 year
 for
 through
 the
 school
 would
 cover
 a
 doctor’s
 visit
 in
 a
 different
 state.
 I
 called
 the
 insurance
 company
 to
 check
 and
 they
 said
 they
 cover
 any
 doctor
 in
 the
 country.
 Happy
 to
 hear
 this, 
I 
called 
and 
made 
an 
appointment 
with 
the
 doctor 
I 
had
 been
 seeing 
for 
years.

Though
 my
 insurance
 had
 changed,
 my
 doctor’s
 appointment
 was
 the
 same
 as
 always,
 I
 just
 had
 a
 slightly
 higher
 co‐pay.
 I
 had
 a
 routine
 check‐up
 and
 the
 doctor
 ordered
 some 
blood
 tests 
to 
help 
diagnose 
my 
problem.
Within
 a
 few 
weeks,
the 
doctors 
figured 
out
 what
 was
 wrong
 and
 cured
 it.
 I
 returned
 to
 school
 in
 September
 happy
 and
 healthy.
 As
 far
 as 
I 
knew, 
my
 business 
with 
the 
doctor 
was 
finished.Continue reading…

“Trust Us” Just Doesn’t Cut It

• 1

By PAUL LEVY

I apologize in advance if some of you are tired of hearing about Massachusetts and its experience with different payment models for health insurance. I write about this, not only because it is interesting locally, but also because people around the US are watching to see how the experiments here might or might not be applicable to the rest of the country.

I have written before about the pro’s and con’s of capitated, or global, payments as an alternative to fee-for-service payments. There are arguments to be made in support of each. But the problem in this state is that the movement towards global payments has become a matter of religious dogma. The main practitioners of the system have not been willing to divulge the kind of information needed to evaluate it properly. That lack of transparency undermines the policy arguments that might be used to advocate for an expansion of this approach.

But, eventually, more and more of the story comes out, and it is less than pretty. A few weeks ago, I quoted a report by the state’s Inspector General in which he raises concerns about this issue. He noted, “[M]oving to an ACO global payment system, if not done properly, also has the potential to inflate health care costs dramatically.”

Now comes an article by Pippin Ross in Commonwealth Magazine, entitled “Piloting Global Payments.” It has some revelations that give credence to the concerns raised by the IG.

Ross quotes a Blue Cross Blue Shield official as saying:

Blue Cross padded first-year global payment budgets to entice hospitals and doctors to sign on…. [T]he current goal is not to actually reduce costs, but to cut in half the rate of growth in medical costs after five years.

[T]he outcomes after one year under global payment are where Blue Cross expected to be in three or four years. “The amount of money being spent hasn’t changed yet, but the outcomes are serious testimony to the fact that more—in tests and doctors and visits—isn’t always better,” she says. “We’re getting a lot more for our money than we expected.”

But, of course, we don’t really know, do we? We have no way to validate any of this. Sorry, but “trust us” just doesn’t cut it when it comes to this kind of significant change.Continue reading…

Why Medicare Isn’t the Problem, It’s the Solution

• 200

By ROBERT REICH

I hope when he tells America how he aims to tame future budget deficits the President doesn’t accept conventional Wasington wisdom that the biggest problem in the federal budget is Medicare (and its poor cousin Medicaid).

Medicare isn’t the problem. It’s the solution.

The real problem is the soaring costs of health care that lie beneath Medicare. They’re costs all of us are bearing in the form of soaring premiums, co-payments, and deductibles.

Americans spend more on health care per person than any other advanced nation and get less for our money. Yearly public and private healthcare spending is $7,538 per person. That’s almost two and a half times the average of other advanced nations.

Continue reading…

Turf Wars

• 6

By MICHAEL KIRSCH, MD

So many folks express views that are obviously self-serving, but they try to masquerade them as altruistic positions that benefit some other constituency. These attempts usually fool no one, but yet these performances are common and ongoing. They are potent fertilizer for cynicism.

Teachers’ unions have been performing for us for decades. Their positions on charter schools, school vouchers, merit pay and the tenure system are clear examples of professional advocacy to protect teachers’ jobs and benefits; yet the stated reasons are to protect our kids. Yeah, right. While our kids are not receiving a top flight education, the public has gotten smart in a hurry on what’s really needed to reform our public educational system. This is why these unions are now retreating and regrouping, grudgingly ‘welcoming’ some reform proposals that have been on the table for decades. This was no epiphany on their part. They were exposed and vulnerable. They wisely sensed that the public lost faith in their arguments and was turning against them. Once the public walked away, or became adversaries, established and entrenched teachers’ union views and policies would be aggressively targeted. Those of us in the medical profession have learned the risk of alienating the public. Teachers have been smarter than we were.

The medical profession is full of ‘performances’ where the stated view is mere camouflage. For example, there is a turf war between gastroenterologists (GI) and anesthesiologists whether GI physicians can safely administer the drug propofol to sedate our patients before colonoscopies and other glamorous procedures. This drug may be familiar to ordinary readers as it was involved in the death of a superstar pop music legend in 2009. GI doctors insist that with proper training we can safely administer this drug to our patients. Indeed, there are numerous scientific publications that support this view. Anesthesiologists have pushed back hard and they have prevailed. “It’s too dangerous,” they warn. “No one can use this drug unless you have advanced anesthesia training,” Of course, the only physicians who have ‘advanced anesthesia training’ are anesthesiologists. I’m not claiming that my anesthesia friends don’t have a legitimate point. But, let’s be clear. Their position is not merely an effort to protect patients, it is also meant to protect their turf. Continue reading…

The Science and Religion of Patient Safety

• 3

By BOB WACHTER, MD

Earlier today, Secretary of Health and Human Services Kathleen Sebelius and Medicare chief Don Berwick announced the “Partnership for Patients,” a far-reaching federal initiative designed to take a big bite out of adverse events in American hospitals. The program – which aims to decrease preventable harm in U.S. hospitals by 40 percent and preventable readmissions by 20 percent by 2013 – marks a watershed moment in the patient safety movement. Here’s the scoop, along with a bit of back story (which includes a gratifying bit part for yours truly).

Last July, I attended the American Board of Internal Medicine’s Summer Forum in Vancouver. This confab has turned into medicine’s version of Davos, drawing a who’s who in healthcare policy. One of the attendees was an old friend, Peter Lee, a San Francisco lawyer and healthcare consumer advocate who had just been asked to lead a new Office of Delivery System Reform within the U.S. Department of Health and Human Services. Peter’s charge was to figure out how to transform the delivery of healthcare in America, challenging under any circumstances but Sisyphean given that he’d be pushing the rock up a mountain chock full of landmines comprised of endless legal and political threats to the recently-passed Affordable Care Act.

Fueled by the enthusiasm of being a new guy with a crucial task, Peter took advantage of some conference downtime to convene a small group – about 20 of us – to advise him on what he should focus on in his new role. After soliciting ideas from many of the participants around the table, he turned to me. I decided not to be shy.

I suggested that the topic of patient safety remained compelling and scary, and that it might be at a tipping point – with new success stories in reducing infections and improving surgical safety, more hospitals possessing the infrastructure to improve safety, and increasing penetration of IT systems due to federal support through the meaningful use standards. I also knew that Don Berwick, Peter’s new boss, would not be content to move around some bureaucratic chess pieces, or even a few hundred million dollars. Instead, he’d be looking to do Something Big – an initiative aimed at capturing hearts and minds, a federal version of his IHI 100,000 Lives and 5 Million Lives campaigns. What better target than patient safety?Continue reading…

The Partnership for Patients: The Inside Scoop on a Game Changing Safety Initiative

By BOB WACHTER, MD

Earlier today, Secretary of Health and Human Services Kathleen Sebelius and Medicare chief Don Berwick announced the “Partnership for Patients,” a far-reaching federal initiative designed to take a big bite out of adverse events in American hospitals. The program – which aims to decrease preventable harm in U.S. hospitals by 40 percent and preventable readmissions by 20 percent by 2013 – marks a watershed moment in the patient safety movement. Here’s the scoop, along with a bit of back story (which includes a gratifying bit part for yours truly).

Last July, I attended the American Board of Internal Medicine’s Summer Forum in Vancouver. This confab has turned into medicine’s version of Davos, drawing a who’s who in healthcare policy. One of the attendees was an old friend, Peter Lee, a San Francisco lawyer and healthcare consumer advocate who had just been asked to lead a new Office of Delivery System Reform within the U.S. Department of Health and Human Services. Peter’s charge was to figure out how to transform the delivery of healthcare in America, challenging under any circumstances but Sisyphean given that he’d be pushing the rock up a mountain chock full of landmines comprised of endless legal and political threats to the recently-passed Affordable Care Act.

Fueled by the enthusiasm of being a new guy with a crucial task, Peter took advantage of some conference downtime to convene a small group – about 20 of us – to advise him on what he should focus on in his new role. After soliciting ideas from many of the participants around the table, he turned to me. I decided not to be shy.Continue reading…

Time to End The Health Care Tax Exclusion?

• 4

By MERRILL GOOZNER

President Obama on Wednesday will unveil his counter offer for bringing the nation’s budget deficit under control. Last week, the Republican plan authored by Rep. Paul Ryan, R-Wisc., chairman of the House Budget Committee, focused public attention on cutting health care subsidies for seniors and low-income people.

Will the president go after the bloated health care sector, too?

Here’s one way he could raise a half trillion dollars in the next four years from health without touching seniors or the poor. The plan would win plaudits from tax purists and deficit hawks. And it would make a major contribution to holding down the growth in health care costs, while testing Ryan’s claim to back putting tax expenditures on the table.

The president should propose eliminating the income tax exclusion for health care benefits.Continue reading…