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.
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.
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.”
Commentology > More On Natasha Richardson
Dr. Cory Franklin dropped us a note in response to THCB contributor Sarah Arnquist’s piece on the controversy surrounding the death of British actress Natasha Richardson, “Leave Natasha Richardson Out of the Healthcare Debate.”
“I wrote the article and have been reluctant to respond to criticisms
but since I read your blog I will here. So many people, both sides, are
tied into their political beliefs about health care that virtually no
one is actually looking at the record as we know it and asking a quite
logical question.1. Here’s what’s important- the facts of this case- check the 911
transcripts in the Globe and Mail. The paramedics document the patient
has a Glascow Coma Score of 12 upon arrival to the first hospital at
St. Agathe. That is the key. The medical literature is quite clear –
patients who present with scores in that range on presentation almost
always survive. Where are the Canadian neurosurgeons and trauma people
commenting on that? The questions that should be asked in light of that
are who made the diagnosis and when, who treated and when, and what was
the condition upon treatment. But it is clear that at 4 PM she was
neurologically intact enough to survive with the appropriate treatment.
By the way, this major ski resort is no further from Montreal than Vail
or Breck is from Denver. And the Canadian defenders talk about how
close it is by ambulance to minimize the medevac issue. You can’t have
it both ways.
Whose Data is it Anyway ?
As we know, the Federal Government is planning to spend $19 billion to help the healthcare system upgrade its 20th century, non-standard, paper-based and proprietary system-based health records systems to a more standardized, electronic solution which will empower the healthcare system and consumers alike. This may be a side benefit of electing our first Blackberry-toting commander-in-chief. But, it’s not clear that everyone is ready to get behind the President on this one.
The New York Times just published an article entitled “Doctors Raise Doubts on Digital Health Data”. The New England Journal of Medicine just published two articles outlining the challenges with making the electronic records dream a reality.
In a recent post on this blog entitled, “Better Records on Our Cars Than Ourselves“, we discussed the critical importance of better connecting consumers to the healthcare decision-making and delivery process. Without engaging consumers effectively, it will be difficult to drive meaningful changes in healthcare consumption, healthcare effectiveness and ultimately, healthcare cost.
While the recent flurry of media coverage on the subject of electronic health records points to many of the reasons why the Government’s plan cannot or will not succeed, let’s take a minute to focus on why it should succeed:
1. Health information belongs to the consumers whose health is in question. While the information may be generated by doctors and other members of the delivery system, it is generated on patients and generally paid for by the patients themselves or their insurers (private or government).
2. Patients can and should be able to access and share their health information. Is it really appropriate, as some have argued, for some doctors or other members of the delivery system to decide if we, as patients, are “qualified’ to have access to our own health information ?
3. Getting health records into a more standardized, usable and transferrable format will surely take time and cost a lot of money. One potential benefit of this investment of time and money may be a new partnership between those who deliver healthcare and those who consume heathcare. In an industry which is today characterized by battling between constituents over who gets what care and who pays for that care, a bit of partnership might go a long way. Cal it a pollyanna-ish view, but without a vision to make things better we are may well be destined to mediocrity.
Why not focus on what we can accomplish vs what we cannot ? Why not begin architecting a plan to migrate from reliance on proprietary systems and paper records to an open, electronic solution that brings healthcare information together vs keeping it in protected silos ?
In closing, as the New York Times and New England Journal articles discuss, it seems appropriate to debate how the new electronic information will be used to improve healthcare quality. But, this debate can proceed in parallel with an effort to make the information more readily available in the first place. Without substantive changes to how we collect, store and transfer health information, the healthcare quality debate may stay just that – a debate.
Doug Klinger serves on the board of MedCommons. Before joining MedCommons, spent ten years with CIGNA, where he served as CEO of CIGNA Dental, among other roles. His resume includes a stint with Monster.com, where he led the company’s North American unit.
