Category: Uncategorized

The Primary Care Revolt

Sep 14, 2011• 19

By brian klepper

Last Thursday Anna Wilde Mathews of the Wall Street Journal ran an article detailing the activities surrounding primary care’s gradual awakening and mobilization. With Tom McGinty, Ms. Mathews authored a damning expose on the RUC last October that precipitated our efforts against CMS’ 20 year reliance on the AMA’s RVS Update Committee (RUC) for valuation of medical services.

There is the lawsuit by six Augusta, GA primary care physicians, spearheaded by Paul Fischer MD. (See his most recent article below). The suit claims that CMS’ and HHS’ longstanding primary relationship with the RUC has rendered that panel a “de facto” federal advisory committee. That would make it subject to the management and reporting rules of the Federal Advisory Committee Act – transparent proceedings, representative composition, scientifically valid methodologies – that attempt to ensure the public over the special interest. The fact that CMS has never required the RUC to adhere to those rules presumably means that the relationship is out of compliance with the law.

The American Academy of Family Physicians (AAFP), after declining to join the suit, issued a series of demands: more primary care seats, a sunsetting of rotating sub-specialty seats, a dedicated gerontology seat, seats for non-physicians like patients, purchasers and economists. The RUC has until March to respond. If they reject the demands, the question is whether the AAFP Board will vote to walk, as David Kibbe and I urged them to do when we began this campaign last January.

Say It Loud, I’m a Gimp and I’m Proud!

Sep 14, 2011• 2

By Marc Stecker

Apologies to James Brown for the title of this post, as his 1968 funk classic “Say It Loud, I’m Black and I’m Proud” (click here to listen) helped galvanize the civil rights movement in America, offering a joyous rallying cry to people who for far too long had suffered at the hands of racism and oppression. The song was not only a shout of protest, but an admonition to embrace the very thing that conferred minority status on an entire people and turn what for some had at one time been a mark of shame into a badge of honor. On top of all that, the song irresistibly generates the urge to get up and shake your groove thing. That is, of course, if you are able to get up at all.

Those of us whose disease has progressed to the point where shaking our groove things is a distant memory and has left us visibly disabled – reliant on canes, walkers, or wheelchairs – also find ourselves members of a minority group, the disabled, the inclusion in which leaves some feeling invisible, helpless, and diminished. Much of the world simply isn’t designed for people who don’t have full use of their limbs, and the fully functional folks who populate it can be insensitive, uncaring, ignorant, and sometimes even intolerant. Though much progress has been made in in the fight for the rights of the disabled, the struggle is closer its beginning than its end.

Throughout much of history, victims of chronic illness, particularly of the kind that deform or disable, have often been looked upon with scorn, as if getting sick was somehow a mark of shame, the afflicted somehow responsible for their own affliction.

ONC Invests in Innovation Challenges

Sep 14, 2011• 1

By Matthew Holt

Health 2.0 is thrilled to announce that we are launching two challenges as part of the official kick-off of the Investing in Innovation (i2) program. Over the next 2 years the ONC will be issuing nearly $2 million in prize money for numerous challenges all designed to inspire innovation in health information technology. Along with our colleagues at Capital Consulting Corporation, Health 2.0 is the contractor supporting this effort. We started with a joint NCI/ONC effort which is already underway, but now the first two challenges are live. And they are:

Reporting Device Adverse Events Challenge ONC is asking multi-disciplinary teams to develop an application that facilitates the reporting of adverse events related to medical devices, whether implanted or used in the hospital, clinic, or home. This challenge has $40,000 in total prizes
Ensuring Safe Transitions from Hospital to Home Challenge. ONC is challenging software developers to improve care transitions and build upon these tools by generating an intuitive and easy-to-use application to empower patients and caregivers that fits into existing ways that providers communicate. This challenge also has $40,000 in total prizes.

These are both critical parts of health care where new innovation can make a big difference–and developers can win a substantial prize to get them on their way.

Have We Not Been Looking at Things We Should Have Seen?

Sep 13, 2011• 1

By PAUL LEVY

A remarkable aspect of the Parkland Memorial Hospital saga was the degree to which the hospital’s Board was not given information by senior management about the clinical outcomes in their hospital. The lack of transparency, in other words, even went to management’s relationship with its fiduciary board.

A recent article by the Dallas Morning News outlines some of these points:

On August 19, the hospital’s seven-member board of directors got its first chance to read the full report by the U.S. Centers for Medicare & Medicaid Services. Almost 10 days had passed since [the CEO] first received the findings. As members began leafing through pages of the report, surprise, even shock, began to register.

The Chair of the board said, “We had direct culpability, but none of us even knew we were in the report.”

The Anti-Injunction Act Complications

Sep 13, 2011• 8

By BRAD JOONDEPH

The big news from [last Friday’s] two decisions was not that Virginia lacks standing; that was a problem lurking in that case from the beginning, a nettlesome issue going all the way back to Judge Hudson’s first opinion (in August 2010) rejecting the United States’s motion to dismiss on 12(b)(1) grounds. Virginia would have stood on much stronger ground had it also alleged an injury in fact from the effect of the minimum essential coverage provision’s necessarily pushing more Virginia residents onto the state’s Medicaid rolls, and thus imposing a significant financial cost on the state. But the Commonwealth failed to do this, instead resting on the claim that it had standing based on the alleged “conflict” between its Virginia Health Care Freedom Act and the individual mandate. This was a weak argument from the beginning, and the Fourth Circuit’s holding was entirely unsurprising.

What is surprising–perhaps not on the merits, but in relation to the attention the issue has received to date, from the courts and the parties–is the court’s holding in Liberty Universityv. Geithner that federal courts lack any subject matter jurisdiction over a suit seeking to enjoin enforcement of the individual mandate because such jurisdiction is precluded by the Anti-Injunction Act. In this respect, there are some important points worth noting:

* This is a potential problem in every lawsuit currently challenging the individual mandate. That is, if the Fourth Circuit’s analysis is correct, then the Supreme Court would lack jurisdiction to hear any private plaintiff’s claim that the minimum coverage provision exceeds Congress’s enumerated powers until after a taxpayer was assessed a penalty under ACA 1501, paid the penalty, and sued the federal government for a refund. The case thus would not reach the Supreme Court until somewhere in the neighborhood of 2015 or 2016.

The Doctor is Social

Sep 12, 2011• 2

By Jane Sarasohn-Kahn

Doctors and hospitals are going social, adopting social media for professional and clinical use, based on surveys conducted in mid-2011 by QuantiaMD and Frost & Sullivan and the Institute for Health Technology Transformation (iHT2).

In Doctors, Patients & Social Media, dated September 2011, QuantiaMD and the Care Continuum Alliance report a high level of physician engagement with online networks and social media. Two-thirds of physicians are using social media for professional purposes, and see potential in the use of these channels to facilitate patient-physician communication. The survey found a cadre of “Connected Clinicians” who use multiple media sites to positively impact patient care. Over 20% of clinicians use 2 or more sites.

Only 1 in 10 physicians is familiar with one or more online patient communities, as the first chart illustrates. Among those who know about at least one community, a majority believe the sites have a positive impact on patients (either very positive or positive in the survey response). This is true across various condition categories, especially for rare diseases, cancers, chronic conditions, maternal and child health, and wellness/prevention. As one physician shared anecdotally, “Patients can share their stories, learn from others, spread knowledge, and instill hope.”

AHIP Video Series: McKesson

Sep 12, 2011• 2

By DEB LINTON

Continuing with our AHIP Video Series, Health 2.0 and THCB sat down with McKesson‘s VP of Decision Management, Matt Zubiller. McKesson Corporation is the world’s largest and oldest healthcare services company, and McKesson Health Solutions (MHS) is its payer-focused business unit. For 35 years, MHS has delivered solutions with the industry’s soundest and most widely used clinical evidence and expert technology to help payers and providers collaborate to achieve better healthcare outcomes at lower costs. Each solution in the MHS portfolio is designed to decrease administrative costs, create efficient provider networks, manage both risk and medical costs, and improve care quality and outcomes. In this video, learn more about why MHS solutions touch more than 160 million covered lives, and are used by 96% of the top 25 health plans, payers of all sizes, 4,000 hospitals, and numerous federal agencies.

Yes, The Federal Exchanges Can Offer Premium Tax Credits

Sep 12, 2011• 24

By TIMOTHY STOLTZFUS JOST

Whatever else the Affordable Care Act may accomplish, it has provided endless entertainment for law professors.

The latest ACA kerfuffle involves the discovery by critics of the ACA of an ACA drafting error that would seem to deprive millions of uninsured Americans of tax credits to purchase health insurance and invalidate regulations recently proposed by HHS and the Treasury Department. The mistake is found in section 1401 of the ACA, which creates a new section 36B of the IRC. Two subsections of 36B ((b)(2)(A) and (c)(2)(A)(i)) suggest that premium tax credit eligibility under the ACA depends on the applicant being enrolled in a qualified health plan “through an Exchange established by the State under section 1311.” This would in turn suggest that individuals enrolled in a qualified health plan through a federal exchange established under section 1321(c) would not be eligible for premium tax credits, contrary to the recent proposed regulations.

That this is a drafting error is obvious to anyone who understands the ACA. Section 1311 of the ACA requests the states to establish American Health Benefit Exchanges and sets out the duties of the exchanges. Section 1321 of the ACA, however, provides that if a state elects not to establish and exchange or fails to do so, HHS must “establish and operate” an exchange in such a state and “take such actions as are necessary to implement” the other requirements of title I of the ACA, which includes section 1401. There is no coherent policy reason why Congress would have refused premium tax credits to the citizens of states that ended up with a federal exchange. None of the CBO reports scoring the ACA suggest that premium tax credits would only be available though 1311 state exchanges and not through 1321 federal exchanges. It is, finally, highly unlikely that the House, whose bill included only a federal exchange, would have approved a bill that only provided tax credits through state exchanges but not through the federal exchange.Continue reading…

We’re From The Government. We’re Here To Help …

Sep 11, 2011• 5

By WHITECOAT, MD

The clock is ticking for Parkland Memorial Hospital in Dallas.

Earlier this month, Parkland was cited by the Centers for Medicare & Medicaid Services for several “serious threats” to patient safety. As a result, the hospital is now in jeopardy of losing its ability to participate in the Medicare program unless it submits “correction plans” to CMS by August 20, 2011.

According to a CMS spokesperson, two violations relating to infection control and emergency care issues were “so serious that they triggered ‘immediate jeopardy’” for the hospital. In fact, the reasons for the citation were so heinous that CMS won’t even disclose them to the public until Parkland submits plans on how to fix those super secret problems. That’s the subject of another WTF discussion, but we’ll save that one for later.

The event triggering the CMS investigation involved a schizophrenic psychiatric patient with a heart condition who died while in the emergency department. The report states that the technicians who subdued the man did not have “effective training” and that the patient was not closely monitored before his death.

According to the article and an interview Parkland’s Chief Medical Officer, Parkland was cited for several reasons. Based on what I can gather from the article, two of the hospital’s citations were for:

– Moving patients with less serious symptoms to a separate urgent care center for medical screening
– Staff touching a patient and then touching other surfaces that people would come into contact with

Think about how grave these dangers are.

Time to Make Joint Commission Surveys Public

Sep 11, 2011• 1

By PAUL LEVY

Can anyone doubt that the recent kerfuffle faced by Parkland Memorial Hospital in Dallas would have had a greater chance of being avoided if earlier reviews by the CMS-designee, the Joint Commission, would have been made public? Yet, JC surveys are held in confidence. This is a matter of federal law.

Currently, the results of hospital accreditation surveys cannot be accessed by the public under Section 1865 [42 U.S.C. 1395bb] (b) of the Social Security Act, which reads as follows:

“(b) The Secretary may not disclose any accreditation survey (other than a survey with respect to a home health agency) made and released to the Secretary by[615] the American Osteopathic Association[616] or any other national accreditation body, of an entity accredited by such body, except that the Secretary may disclose such a survey and information related to such a survey to the extent such survey and information relate to an enforcement action taken by the Secretary.”

When I was CEO of a hospital, we voluntarily made our JC surveys public, posting them on our corporate website. We felt that it was important for all staff in the hospital to have the chance to review the findings and act on them, and we also felt that public confidence in our hospital would be enhanced by this kind of transparency. While this practice has spread somewhat, most hospitals still do not make their surveys public.