Author Archives

Matthew Holt

Stimulus bill offers docs big incentives for technology, but demands effective use

Feb 6, 2009• 35

By John Haughton, MD

The economic stimulus bills are a great step forward for health information
technology and medicine.

The two bills, “HR1” and “S1,” continue to barrel down the legislative track and continue being amended, but as currently written they create real incentives for adopting certified electronic health records – upwards of $40,000 per physician starting in 2011.

The legislation emphasizes rewarding designs that improve care and create a path for certification of records with added functions, such as decision support, order entry, connections to other systems and reporting on quality measures. The bill focuses on implementation by tying the physician bonuses to proven, effective use. The stimulus package also formalizes the Office of the National Coordinator for Health information Technology (ONC).

Of the nearly $900-billion stimulus package, about $20 Billion would go to Health and Human Services, with $6 billion for the Office of the Secretary of Health and Human Services. Of that $6 billion, $2 billion would be for the Office of the National Coordinator (ONC) to support information technology.

Commentology

Feb 6, 2009

The anonymous eDoc had this to say about Merrill Goozner's report that Obama may be considering Emory's Ken Thorpe as a replacement for Tom Daschle:

"As a member of the Emory community, I know Ken Thorpe as a mover and a shaker in the area of public health with strong ties to the CDC (his office is literally next door to the CDC). He has Washington experience as Deputy Assistant Secretary for Health Policy during the early years of the Clinton administration, and has testified before Congress a number of times on public health issues. There is no stronger advocate for public health and preventative care than Thorpe."

Saving Medicare Advantage the Easy Way

Feb 6, 2009• 24

By AL LEWIS

Brokers who enroll senior citizens in Medicare Advantage (MA) plan often make more on those members than the health plans themselves. Up to $500 can be spent on a broker fee by the health plan, contributing to a total member acquisition cost which can exceed 10% of the premium dollar. Even if Medicare Advantage plans can deliver the actual health benefit at a considerably lower cost than Medicare Fee For Service (FFS), it is possible that the entire savings could be consumed by member acquisition costs.

These costs are a tax on Medicare as a whole, a tax whose existence becomes simply unsupportable when the dire forecasts of Medicare solvency are considered. And an unnecessary burden on health plans as we enter an era in which cutbacks are likely.

The solution is easy enough. Where MA is available, make Fee For Service an Opt-Out rather than something which has to be “sold.” When the benefits of both FFS and the various MA plans are laid side by side and people are told that they can simply select a plan from the chart or else complete a lot of paperwork to go FFS, more people will select the MA plans without a broker than would select those plans with an expensive broker if they are put in FFS originally and need to be “sold” to get into an MA plan.

The AMA Wins a Round Against Accountability and Patient Information

Feb 6, 2009• 13

By Brian Klepper

On January 30th, a 3-judge DC appeals court overturned a lower court decision that would have forced public release of Medicare physician data. Writing for the majority in a split 2-1 judgment, Circuit Judge Karen LeCraft Henderson declared that

“The requested data does not serve any (freedom-of-information-related) public interest in disclosure. Accordingly, we need not balance the nonexistent public interest against every physician's substantial privacy interest in the Medicare payments he receives.”

But in a strongly worded dissent, Judge Judith Rogers, the third member of the ruling panel, found that the request by the consumer group, Consumer Checkbook, represented “a commanding and important public interest in disclosure of the data.”

Calendar: Fourth National Pay For Performance Summit

Feb 6, 2009

Sponsored by the Integrated Healthcare Association. Co sponsored by Bridges to Excellence, Leapfrog Group, the National Business Coalition on Health, the National Committee of Quality Assurance and the National Quality Forum. March 9 – 11, 2009 San Francisco, CA.www.PFPSummit.com

Daschle out at HHS – Sharfstein in at FDA?

Feb 6, 2009• 21

By MERRILL GOOZNER

The early stages of the Obama administration are beginning to
resemble the Clinton years, which I
observed from afar (I was a foreign
correspondent in Tokyo at the time). Take Zoe Baird and substitute Tom
Daschle, who dropped out of the running for Secretary of Health and
Human Services today because of tax and conflict-of-interest problems.
Take gays in the military and substitute putting in charge of the bank
bailout a man (Tim Geithner) who knows all the bankers from his years
at the New York Fed, seems overly solicitous to their needs, and has
his own tax problems.

Once again, a new Democratic president appears to have a semi-automatic weapon semi-permanently aimed at his foot.

The Case for Ron Wyden

Feb 5, 2009• 17

By ROBERT LASZEWSKI

Let me be the first to suggest that the President name Senator Ron Wyden (D-OR) to be the next
Secretary of HHS. The withdrawal by Tom Daschle has underscored just how important it will be for the President to name someone who can bring a number of key strengths to the job.

All day reporters have been asking me whom the best person was for the
President to now turn to and get his health care agenda back on track.

Seems to me Ron Wyden fits the bill.

Berwick “Perfectly Designed” for HHS Secretary Post?

Feb 5, 2009• 10

By Michael L. Millenson

Several well-informed sources independently told me that Institute for Healthcare Improvement founder Dr. Donald Berwick had been chosen by the Obama administration to run the Centers for Medicare & Medicaid Services — a fascinating selection. (This article, though, reminds us of Don’s background in public health and in government commissions that deal with a broad swath of the policy elite.)

But would Berwick continue to agree to serve under an HHS secretary with less prestige, Congressional clout, presidential access and deep understanding of health care than Tom Daschle? I’m presuming here that Berwick already had a personal relationship with Daschle and his senior advisers. Still, Berwick has spoken in recent months of reform from “the inside out,” and there are few “insider” positions with more influence over health care than being in charge of the Medicare program.

The Perils of Play or Not Pay

Feb 5, 2009• 12

By ROGER COLLIER

Remember those heady days with a newly-elected Democratic President and solid Democratic majorities in both houses of Congress, when it seemed that national health care reform was just around the corner? Remember how, after the face-off between the liberals who wanted a single-payer system and the conservatives who wanted as little change as possible, the centrists took command? Remember the early 1990s, and play-or-pay as the magical way to universal coverage?

So you do remember play-or-pay? Be careful about admitting it. After the failure of the Clinton plan and the collapse of similar state reforms in Washington and Massachusetts, a mere mention of the term would cause political eyes to roll, while its inclusion in any reform plan was enough to kill the proposal dead, dead, dead.

Op-Ed: Why the Senate should be abolished, Parts 34-36

Feb 5, 2009• 22

By Matthew Holt

Irrelevant small states with no people in them that exist by an accident of history are chronically over-represented in this country — both in the electoral college and most obviously in the Senate. And those states are much more conservative than metro areas where people actually live, which means that even if they send Democrats to DC, they’re not exactly raging Trotskyites.

Hence we get Max Baucus, representing less than 1 million people, or one-sixth of an average state’s population, pushing moderate reform and saying that single-payer is a political non-starter. He’s right, but it’s only because of the political structure that guarantees him his power. If San Francisco, which has roughly the same population as Montana, sent a Senator to Congress I think the result would be somewhat different.