So we're going to start with one of the more controversial people I'm meeting at HIMSS, Andy Slavitt the CEO of the newly discovered and reviled by the Senate Ingnix. As you may recall, despite the fact that (not entirely to Andy's pleasure) I called them arms dealers, I was not entirely unsympathetic to what Ingenix was up to in the recent mess. So I talked to Andy about that, about what Ingenix actually does and whether it made sense for a health plan to own a big informatics company (his short answer…they don't!) An interesting interview you can see immediately below.
Matthew Holt
Op-Ed: Let’s Pay Nurses Minimum Wage!!
Every morning I wake up and thank God that we still have some Republicans in Congress. Representative John Shadegg (R) from Arizona, is one of those blessings. He has introduced a bill in Congress called the Nursing Reform Act of 2009. The bill calls for increasing work visas for foreign nurses (and their spouses). When passed, it will eliminate the nursing shortage!
This bill is great on so many levels. For one, everyone knows that healthcare is costing us an arm and a leg (pun intended). The biggest causes are obviously nurses and nursing unions. Nurses are way overpaid, but unfortunately the healthcare corporations have not been able to break the nursing unions because of the shortage of nurses. By bringing in lots of foreigners, they can flood the market with labor, break the unions, and get nursing salaries down to where they belong — somewhere around what retail pays. If only there weren’t that law capping the number of foreign nurses we allow in the country… As a side benefit, the bill allows for nurses’ spouses to get unrestricted work visas as well, so it will help bring down salaries in all sorts of other industries as well!
The true brilliance of this bill (thank you Mr. Shadegg!) is in the way it is written. It doesn’t bring them all in at once. It starts out with 50,000 new visas the first year, which is a low enough number that people will “buy it” and the bill can get passed. Supporters of the bill have had to go to great lengths to say that nursing salaries will be unchanged, which of course will be true at first. However, the genius in the bill (evil grin) is that the number of allowable visas automatically goes up 20% per year, so it will be 60,000 visas in year two, 72,000 visas in year three, 86,400 visas by year four, 103,680 by year five, and a whopping 124,416 by year six! The bill states that “According to the Department of Labor, the current national nursing shortage exceeds 126,000.” Therefore, the nursing shortage will be solved in about six short years, and healthcare companies can get back to earning the kind of money they deserve! Incidentally, this is just the approach that was so successful in cutting the salaries earned by information technology workers about 10 years ago. Corporate profits were getting impacted by high IT costs, so our brilliant Congress increased the number of H1-B visas, and companies were able to hire cheap workers from India and other places. Thank you, Congress! Later, many of these foreign workers returned to their homelands and brought the work with them. Now, corporate America doesn’t have to pay high salaries, and they don’t even have to look at the foreigners anymore — they can just write a little check to India. Bravo! Fortunately, information technology salaries have never rebounded to the levels where they were.
“Mr. Obama, Tear Down These (Hospital) Walls”
I like readmissions. Well, that didn’t come out quite right, did it?
What I mean is that I like focusing on readmissions as a potentially actionable quality measure. I believe that it’s possible to prevent many readmissions, thereby improving quality and lowering costs. And compared to mortality (the other hot outcome measure), the need for case-mix adjustment is a bit less critical, and there is no such thing as “a good readmission.”
I also like DRGs. Paying hospitals a fixed fee for a given diagnosis has created the only corner of sustainable capitation in our healthcare system, one that is otherwise awash in inappropriate expenditures driven by the dominant fee-for-service payment structure.
But the DRG system created a big black hole, and it is time to fill it. It’s called the post-discharge period. And one large part of the detritus emerging from that hole is readmissions.Continue reading…
Commentology
J Bean was among the commenters who took offense at the line of argument in Steven McKinney’s “Response to Doctors Raise Doubts on Digital Health Data.”
“I guess I have to admit that the EMR industry seems to have hit on a really unique marketing angle. “We have a crappy, overpriced product that would make the buyer’s life worse rather than better, but if they don’t want to buy it, it’s only because they have a psychological hang up. Why wouldn’t that work? Perhaps GM could give it a try too. Of course,
while GM’s cars used to suck, they’ve actually worked to make their
product better. Now they just have to overcome their bad reputation …”
Response to “Doctors Raise Doubts on Digital Health Data” S. Lohr NY Times
1410 Cambridge, England. Minor Canon Thomas Rangle did a final count of the books at Trinity Hall. He counted 122. Most of the books are biblical in nature or celebratory of our good and righteous benefactor Pope Urban V. Few have access to these fine artifacts because of their enormous value (costing as much as a farm or vineyard) and the cloistered clergy and Master of the university are unwilling to share their contents.
1448 Mainz, Germany. Goldsmith and known spendthrift Johannes Gutenberg invented the printing press with move-able type. It is known in town that he has printed school book texts and some indulgences; although, word is out that he is working on a fine bible. Cost is 30 Florins or the equivalent of three years working wages.
From Health 2.0 meets Ix: A Breathtaking Display of Possibilities
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(Boston) Jane Sarasohn-Kahn and I were quickly comparing notes this morning. Our impression is that, compared to past meetings, this one seems more characterized by doers than observers.
This conference brings together a dizzying array of tools and experiences, which is testament to the organizers’ encyclopedic handle on the vast diversity of activity in this sector. Josh Seidman, Indu Subaiya and Matthew Holt have done yeomans’ jobs in putting these impressive presentations together.
Mingling, I’ve spoken to person after person actively involved in mostly consumer-oriented ventures, leveraging science and user-generated information to facilitate a more favorable patient experience. There are some real steps forward, like the demo that Mayo and Microsoft showed, that takes information entered into Health Vault and applies the rules that Mayo has developed through many years of experience. Or the work that groups like Up-To-Date and HealthWise are doing, that continually, organically update descriptive information throughout medicine and health care.
National HIT Symposium at MIT, June 29 – July 2, 2009
OVERVIEW
The recently-enacted American Recovery and Reinvestment Act will
provide more than $35 billion in funding for health information
technology. The health care reform debate in the Congress seems to be
coming to a head this summer. In this context, health care leaders are
grappling with how new emerging policies will impact their
organizations and how to assure that their organizations are
well-positioned to access the significant stimulus funding now emerging
from the federal government.
The HIT
Symposium, conducted at the Massachusetts Institute of Technology in
Cambridge, MA, is a must-attend event, that will help leaders from
every sector of health care, including those representing consumers,
employers, payers, providers, and vendors, gain timely intelligence and
practical insights on how to benefit from the health IT programs and
provisions of the American Recovery and Reinvestment Act. Participants
will hear from the policy leaders responsible for many of the programs
within the federal government, as well as nationally recognized experts
on topics such as privacy, financing, standards, and technical
assistance. In addition, practical insights on how to effectively
access funds from grant programs, and how to support effective health
IT adoption will be shared by veterans in the field. The final day of
the Symposium will be devoted to the role of health IT in health care
reform, which promises to be a hot topic as Congress deliberates health
care reform legislation in the next two months.
The
Health Information Technology Symposium at the Massachusetts Institute
of Technology is the only in-depth executive education event on health
information technology in the United States. It is a must-attend event
for anyone who is responsible for leading and developing programs
responsive to the health IT provisions in the American Recovery and
Reinvestment Act. Register today!
WHO SHOULD ATTEND
- Clinicians
- Hospitals and Other Healthcare Providers
- Health Plans
- Employers and Healthcare Purchasers
- State, Regional and Community-Based Health Information Organizations
- Public Health
- Pharma, Biotechnology and Devices
- Healthcare IT Consultants, Suppliers and Vendors
- State and Federal Policy Makers
- Health Services Researchers
- Academics
Traditional Onsite AttendanceSimply register, travel to the conference city and attend in person.Pros: subject matter immersion; professional networking opportunities; faculty interaction
Live and Archived Internet AttendanceWatch the conference in live streaming video over the Internet and at your convenience
at any time 24/7 for the six months following the event. The archived conference includes speaker videos and coordinated PowerPoint presentations.Pros:
Live digital feed and 24/7 Internet access for next six months;
Accessible in office, at home or anywhere worldwide with Internet
access; Avoid travel expense and hassle; No time away from the office
- A Hybrid Conference, Internet Event and Professional Certification Training Tool
- The Leading Forum on Preparing for Federal Stimulus HIT Funding and Successfully Implementing EHR Programs
- Sponsored by the eHealth Initiative and the MIT Center for Digital Business of the Sloan Business School
- Onsite at Massachusetts Institute of Technology, Cambridge, MA
- Symposium Hotel: Marriott Boston Cambridge
- June 29 – July 2, 2009
- Online In Your Own Office or Home live via the Internet with 24/7 Access for Six Months
To learn more and to register go to: www.HITSymposium.com
The Hive Mind
Over the past few years, I've radically redesigned my approach to
learning. In the past, I memorized information. Now, I need to be a
knowledge navigator, not a repository of facts. I've delegated the
management of facts to the "Hive Mind" of the internet. With Web 2.0,
we're all publishers and authors. Every one of us can be instantly
connected to the best experts, the most up to date news, and an exobyte
multimedia repository. However, much of the internet has no editor, so
the Hive Mind information is probably only 80% factual – the challenge
is that you do not know which 80%.
Here are few examples of my recent use of the Hive Mind as my auxiliary brain.
I
was listening to a 1970's oldies station and heard a few bars of a
song. I did not remember the song name, album or artist. I did remember
the words "Logical", "Cynical", "Magical". Entering these into a search
engine, I immediately retrieved Supertramp's Logical Song lyrics. With
the Hive Mind, I can now flush all the fragments of song lyrics from my
brain without fear.
On Clinical Groupware, Interoperability and the HITECH Bill
By
Was it not Aristotle who once remarked “Nature abhors a front end that is not connected to its backend?”
In his recent, insightful blog here on Clinical Groupware as an alternative “meaningful use” of IT under the Health Information Technology and Economic and Clinical Health Act (HITECH), contained in the American Recovery and Reinvestment Act of 2009, David Kibbe commented that the primary purpose for using these IT systems is to “improve clinical care through communications and coordination involving a team of people, the patient included…in a manner that fosters accountability in terms of quality and cost.”
Yet it takes a “connected” health care ecosystem to make this kind of communication possible, and thus HITECH is replete with references to “interoperability” and “data exchange.” Indeed, the concepts of “meaningful use” and “interoperability” are inextricably linked in HITECH. For example, Section 4102 states that hospital incentive payments are dependent on demonstrating, “that during such period such EHR technology is connected in a manner that provides, in accordance with standards applicable to the exchange of information, for the electronic exchange of information to improve the quality of health care, such as promoting coordination of care.”
Holt accepts Beltway role, pledges new era of ‘personable responsibility’
In a dramatic reversal, THCB publisher Matthew Holt announced today that he has accepted a position with the Washington based CATO Institute, a think tank devoted to sober analysis and rigorous defense of the ideals of the modern conservative movement.
At CATO, Holt will hold the title of Distinguished Visiting British Policy Wonk. He is expected to deliver a series of entertaining lectures designed to warn conservative audiences of the dangers of encroaching big government and the evils of internationalism.
Tentative topics in the series, scheduled to be held at the Rottweiler Student Center at the American University are “What the Hell is Government, Anyway, Really, When You Think About it?” and “Regulation 2.0: Here We Go Again, This Guy Reminds Me of Jimmy Carter ..”
The appointment represents only the latest chapter in a personal voyage spanning three decades and six continents for Holt. In recent years the blogger and entrepreneur had become synonymous with cheeky criticism of the healthcare industry.
“It all started when I read that Ayn Rand book on a bumpy flight from San Francisco to Nashville,” Holt said. “At first, I thought I was going to be sick, then, in a moment of clarity, I became aware of my numerous internal contradictions. By the time I got off the plane I was composing a personable e-mail to Michael Cannon in my head .. ”
Officials at CATO said they were initially skeptical when Holt approached them with the idea that he join the institute, but gradually warmed to the idea, after thinking about it for a little while. “Frankly. we thought it was a bit odd,” said Institute spokesman Chet McClellan “Shit. I mean. Matthew Holt? But people change. Especially in Washington around stimulus package time. ”
In recent months, Holt had been among a number of candidates rumored to have been headed to a high profile role in the White House Office of New Economic Policy. (WHONEP). According to highly placed sources in the administration with an intimate knowledge of events, that lifelong dream came to an premature end last month after Holt offended first lady Michelle Obama with public comments denigrating the Obama Health care reform plan.
According to several witnesses who asked not to be identified, Mrs. Obama flew into an extended rage after learning that Holt had called Mr. Obama’s bold plan to radically reshape the broken US Healthcare System in three months using a handpicked team of people from Massachusetts quote “really silly.”
“Really silly? WTF? The man has a stupid english accent and he can’t spell.” Mrs Obama is reported to have said. “And he doesn’t fact check his blog posts.”
A White House spokesperson denied the incident ever took place.
