Category: Uncategorized

PHR Evolution

May 20, 2009• 5

By JOSH SEIDMAN

I participated in a personal health record (PHR) workshop yesterday hosted by the Center for Democracy & Technology (CDT). CDT’s goal was to gain input from a wide array of stakeholders (an impressive collection of about 40 health care leaders with different types of expertise in PHRs) to help inform CDT’s recommendations to federal agencies — HHS and the Federal Trade Commission (FTC) — and try to build some degree of consensus among key stakeholders.

[NOTE: All comments at the meeting were not for attribution, but I confirmed with the organizers that there was no problem in sharing my own impressions following up from the meeting.]

There’s no doubt that current federal statutes and regulation (and there are potentially many that apply to PHRs) create considerable uncertainty regarding how to balance promotion of consumer engagement with concerns over privacy and security. Existing regulations from HIPAA, the Electronic Communications Privacy Act, and others coupled with the new provision from the American Recovery & Reinvesment Act (ARRA) — not to mention the complexity of layering state laws on top of that — provide a lot of work for privacy attorneys. But with all the different (potentially) applicable federal and state laws/regulation, there is very little practical guidance on what has to go into privacy policies. PHR implementers can find some guidance from FTC consent decrees, which can represent an expansion of the law.

Unlikely conversation partners

May 20, 2009

By Matthew Holt

Do you want to see me and Regina Herzlinger in conversation together? You can sort of do that here. The Center for Connected Health (the Partners guys) had a conversation which was supposed to be three people who’d been at their previous conference talking together. But for some mysterious reason at the last second Herzlinger couldn’t make it. (I sincerely hope that it wasn't because she saw that I’d be on the call!)

So it was Joe Kvedar (from Connected Health). Jay Sanders—who is great by the way—and moi. All talking about the future of remote care. It’s a fun conversation, with Herzlinger’s comments somehow cut in at various times.

By the way, on the topic of everyone’s favorite HBS Professor, last week WellCare settled with the Feds following the raid in October 2007. Apparently the Feds figured that the fraud on Florida Medicaid was about $40m, and that a fine of $80m would be as much as the company could afford (although as far as I can tell they have over $1 billion in cash!). This week on Monday, Wellcare settled with the SEC for another $10m. By the way, Wall Street regards these settlements as good news, and the stock actually has nearly doubled from the depths of last month

Our friends over at Health Care Renewal have put themselves on the Regi shit-list by noticing that she’s still on the board of directors, and they’ll presumably be expecting a letter from her lawyer too. But Roy missed out on noticing (or didn’t report) that Regi sold more than $2m worth of stock a few months before the raid. Not getting soft in your old age are you, Roy?

The Red Flags Rule

May 19, 2009• 7

By JOHN HALAMKA

You may have seen the recent headlines “FTC delays Red Flags Rule
implementation until August 2009”. What is the Red Flags Rule and how
does it relate to healthcare?

The FTC has a great website that it explains it all in detail.

Basically,
the FTC requires most clinical offices, hospitals, and other health
care providers to develop a written program to spot the warning signs
of identity theft – “red flags” If a patient’s name on a photo ID and on their insurance card do not match, that’s a red flag. If a patient visited last week as John Smith but today is Fred Jones, that’s a red flag. If patient seems to travel from provider to provider seeking numerous expensive treatments, that’s a red flag.

The
law was initially designed to cover creditors and it seems odd for
healthcare providers to be considered creditors. The FTC defines a
creditor as anyone who enables the customer to carry a balance after
services are rendered. Unless a clinician asks for payment upfront (all
balances not covered by insurance), the clinician is a creditor.

Disgusting, and another reason why marriage needs to be re-defined

May 18, 2009• 9

By Matthew Holt

Tara Parker-Pope reveals two cases where discrimination kept a partner, and in one case the dying woman’s children, away from their loved one while they were dying in hospital.

One hospital involved is Jackson Memorial in Miami, a massive recipient of Federal dollars. In 1965 then un-integrated hospitals in the south were forced by the Federal government to take black patients as part of the new Medicare program. It’s high time that an executive order was made by Obama that hospitals receiving Federal dollars immediately change their visitation policies in this respect.

But beyond that, those bigots (including the ones who have commented on THCB) who continue to maintain that not changing the legal definition of marriage doesn’t hurt anyone should consider the stories of the people Tara reports about, and they should feel very guilty.

Health Care Leaders Say Obama Overstated Their Promise to Control Costs

May 18, 2009• 13

By ROBERT LASZEWSKI

That was the headline in Thursday’s New York Times regarding Monday’s promise by health care stakeholders to reduce spending by $2 trillion.

A couple of snipets from the Times article:

Hospitals and insurance companies said Thursday that President Obama had substantially overstated their promise earlier this week to reduce the growth of health spending.

“There’s been a lot of misunderstanding that has caused a lot of consternation among our members,” said Richard J. Umbdenstock, the president of the American Hospital Association. “I’ve spent the better part of the last three days trying to deal with it.”

One of the lobbyists, Karen M. Ignagni, president of America’s Health Insurance Plans, said the savings would “ramp up” gradually as the growth of health spending slowed.

Right after the $2 trillion announcement I posted:

Don’t also assume that the American Medical Association (AMA) really represents doctors—I don’t think anyone or anything really represents doctors. If the AMA makes a commitment that actually means sacrifice among the docs you will see just what I mean—especially if the national association folks do a deal with the insurers “on behalf” of all the docs back home requiring real sacrifice. To some degree, you can say the same for the thousands of hospitals out there.

If these stakeholders don’t deliver $2 trillion in something Orszag can take to the bank will the Democratic response be a “public health plan?” Watch the fireworks.

Someone dug themselves one heck of a hole yesterday.

Is it the stakeholders that now have to do in a few weeks what no one has done in decades of pondering this dilemma—make a tangible, measurable, and enforceable offer that cuts real money? If you think coming up with $2 trillion was a big deal actually figuring out the mechanism to carry it off will be a dramatically bigger challenge.

Was it the Obama administration that just raised expectations exponentially trusting these guys can actually deliver something measurable? Or, is the Obama administration just setting them up?

Or was the Obama administration just setting them up?

When those stakeholders walked into the White House on Monday they never intended to make more than a vague promise. When they walked out it was to headlines that they would make “scoreable” proposals by June 1st.

They also had some very angry constituents across the country wondering just what kind of deal they were doing.

They never had $2 trillion and now they have one big problem!

As one insider told me this week, “They got smoked!”

Reconciliation — or War?

May 18, 2009• 9

By ROGER COLLIER

Reconciliation. It’s an odd word for something that could precipitate a knock-down, drag-out fight in Congress, but the process that Senate Democrats agreed last week to adopt if health care reform legislation isn’t passed by October 15 was originally intended to reconcile differences among House and Senate budget bills. What the process does is to replace the usual Senate requirement of a three-fifths majority—needed to end a filibuster, but also consistent with Senate traditions of compromise—by a simple majority.

So, with the Democrats having decided on an aggressive approach (Republican Senator Michael Enzi has called it “like a declaration of war”), what are the implications for the reform legislative process (beyond making Congressional Republicans mad)?

First, is October 15 an absolute drop dead date?

The answer is, not quite. Not only does the reconciliation process provide for up to twenty hours of debate (which could move the deadline out by just two or three days), but Senate Democratic leaders might prefer to continue negotiations on a reform bill if they felt they were close to the magic sixty votes. This would require the vote of at least one Republican, as well as the only Independent (Joe Liebermann), but would allow Democrats to claim bi-partisan support—even if only a little.

Marketplace

May 16, 2009• 1

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Calendar: Project HealthDesign

The Robert Wood Johnson Foundation (RWJF) has announced a new call for
proposals for Project HealthDesign: Rethinking the Power and Potential
of Personal Health Records, a $10-million national program to stimulate
innovations in personal health information technology. Project
HealthDesign will host the second of its informational web seminars for
potential applicants on
May 7th. For more information and to register: http://www.projecthealthdesign.org

Community: SharpBrains Releases 2009 Market Report

SharpBrains is pleased to announce the release of The State of the Brain Fitness Software Market 2009 report, their second annual comprehensive market analysis of the US market for computerized cognitive assessment and training tools. Designed for decision-makers at healthcare, insurance, research, public policy, investment and technology organizations this report contains important information concerning developments in the brain fitness and cognitive health space.

Octomum gives Kaiser a bellyache

May 16, 2009• 3

By Matthew Holt

First KP somehow gets landed with the Octomum, whom they most surely didn’t provided with the IVF in the first place. My assumption is that the multiple birth cost them into the middling 6 figures.

Now because a rogue employee released some of the Octomum’s records, they get hit with another $250K fine! I felt KP made a little too much fuss at the time about their services (the press conference crowing about the birth was a little much). But this is now an example of good deeds getting multiply punished….

SharpBrains Releases 2009 Market Report

May 16, 2009

SharpBrains is pleased to announce the release of The State of the Brain Fitness Software Market 2009 report,
their second annual comprehensive market analysis of the US market for
computerized cognitive assessment and training tools. Designed for
decision-makers at healthcare, insurance, research, public policy,
investment and technology organizations this report contains important
information concerning developments in the brain fitness and cognitive
health space.

The report this year expands to 150+ pages, and has added several new chapters:- Results from a market survey with 2,000+ respondents (decision-makers and early adopters)
– A proprietary Market & Research Momentum Matrix to categorize 21 key vendors into four categories
– 10 Research Executive Briefs written by leading scientists at prominent research labs
– An analysis of the level of clinical validation per product and cognitive domain

This insightful report will be available through direct purchase at a reduced rate for THCB readers strating May 7th, 2009.

UPDATE from the FRESH-Thinking Capstone Conference

May 15, 2009• 2

By TEAL PENNEBAKER

In the same week that the Obama Administration has stated its commitment to overhauling the health care system, the FRESH-Thinking Capstone Conference adjourned yesterday morning to discuss next steps in health care reform. The event is a cross-section of health care experts—academics, practitioners, economists, industry insiders—devoted to fixing the health care system.

The morning began with Stanford Health Policy core faculty member Victor Fuchs welcoming the hundred plus attendees. Fuchs is co-director of the FRESH-Thinking Project with Ezekiel Emanuel. Emanuel stepped down from the Project to join the Obama Administration earlier this year. The Project has spent the past years considering all aspects of health care reform, and this conference is the capstone event of the group's findings. The morning talks look at the cost side of reform.

The first morning speaker was John B. Shoven, Director of the Stanford Institute for Economic Policy Research (SIEPR), who queried the crowd "is it possible to put health care on a diet?" Shoven's focus was on universal coverage and how it can be paid for. After discussing the logistics of who the uninsured are and the current taxation approach, he disavowed the crowd of two giant universal health care reform myths: shared responsibility and the middle class not having to shoulder health care costs. Shoven's take aways were "it's not necessarily that we should have new value added tax. It's that we should have a dedicated tax … We should not separate the benefits from the costs."