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Tag: Brian Klepper

Posts by Brian Klepper

Welcome To Health Wonk Review – 1/09/09

Well, here we are at the beginning of 2009. On TV we’ve learned that the unlimited spending and brilliant, if socially pathological, heroics of Dr. Gregory House, unfailingly saves his patients from unknowable complexity and the abyss of death.

Meanwhile, the rest of health care, aided largely by really excellent lobbying, continues to be buoyed, defying the relentlessly corrosive gravitational pull of waste, corruption, and a tanking economy.

Still, health care’s troops are beginning to feel, in Tom Lehrer’s words, like a Christian Scientist with an appendicitis. Things definitely are not going well, and this longstanding run of great good fortune could be on the downswing. Is it possible that exorbitant pricing and massive waste are NOT entitlements!

Which brings us to the far-ranging insights, jabs, diatribes, rants and enthusiasms of this edition of Health Wonk Review, which features analysis and exegesis as entertainment.

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Let’s Reboot America’s HIT Conversation Part 1: Putting EHRs in Context

Kibbe & Klepper are back with an update to their pre-Christmas piece on EHRs and the forthcoming Obama Administration’s investment policy towards them. Lest you think that this is just a small group here on THCB and fellow traveler blogs shouting to each other, I’d point you towards the Boston Globe article about their previous "Open Letter," which shows that this discussion (and a similar piece on THCB from Rick Peters) appears to be being taken very seriously. As it should–Matthew Holt

On Dec. 19, we published an Open Letter to the Obama Health Team,
cautioning the incoming Administration against limiting its Health
Information Technology (IT) investments to Electronic Health Records
(EHRs). Instead, we recommended that their health IT plan be rethought
to favor a large array of innovative applications that can be easily
adopted to result in more effective, less expensive care.

The
response to that post was vigorous. We received many comments and
inquiries from the health care vendor, professional and policy
communities – urging us to provide more clarity. One prominent
commentator called to ask whether we, in fact, supported the use of
EHRs. We both have been active EMR and health IT supporters for many
years. Dr. Kibbe was a developer of the Continuity of Care Record
(CCR), a de facto standard format for Electronic Medical Records
(EMRs), and has assisted hundreds of medical practices to adopt EHRs.
Dr. Klepper has been involved in EMR projects for the last 15 years,
and the onsite clinic firm he works with provides every clinician with
a range of health IT tools, including EMRs.

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Small Business Coverage: A Report from the Trenches

John Sinibaldi, a well-respected health insurance agent in St. Petersburg, Fla., has become prominent in Florida’s broker community because he counsels and services a large book of small business clients and studiously tracks the macro trends that impact coverage for this population. And he’s active in the state’s regulatory and legislative activities.

The other day I dropped him Jane Sarasohn-Kahn’s post that reported on International Foundation of Employee Benefit Plans’ survey showing that most employers still want to be involved with health care. John responded with a long description of what the small employers he works with are up against. It’s an illuminating, damning piece. I asked him whether I could post it, and he graciously agreed.

John notes that only 36 percent of Florida’s small businesses — employers with two to 50
employees – now offer coverage. This is significant because 95 percent of
Florida businesses are small. Nationally, about one-third of all employees work for firms with fewer than 100 employees.

The increasing pressure on small business may explain why, as I
pointed out the other day, even the arch-conservative National
Federation of Independent Business (NFIB) recently co-sponsored a
reprise of the Harry & Louise health care reform ads
. This time
it advocated for, rather than against, universal health care. Previously,
they were part of the coalition that killed the Clinton reform effort.

Finally, Mr. Sinibaldi’s message should drive home a key point, echoed by Shannon Brownlee and Zeke Emanuel in the Washington Post over the weekend and Bob Laszewski’s post yesterday.
To be successful, the expansive health care reform discussions that
typically dominate in Washington MUST go beyond the Massachusetts and
California reform efforts. Approaches
that can address waste and cost are just as important as those relating
to universal coverage. Otherwise the resulting solutions will continue
to be out of reach to a sizable portion of the American people,
and the underlying driver of the crisis, out-of-control cost, will
remain untouched.

Often the discussions on sites like this are dominated by people who understand health care’s problems deeply but abstractly. For John and his employers, buying health care is a stark, concrete problem that boils down to cutting care arrangements that are affordable for the employers and employees. As he describes it, it’s an increasingly impossible task.

Daschle Tapped for HHS Secretary

The Caucus, the New York Times Political Blog, reports that senior Obama aides have said that Mr. Obama offered the nomination for Secretary of Health and Human Services to Tom Daschle of South Dakota, the former Democratic Senate leader, and that Mr. Daschle has accepted.

Mr. Daschle was an early supporter of Senator Obama. Earlier this year, Mr. Daschle published a well-recieved book called Critical: What We Can Do About The Health Care Crisis.

Two Mea Culpas

Here’s an attempt to recover from two mistakes yesterday. My post on our dismal prospects for real health care reform prompted a couple readers – thanks to Hal Andrews and Fred Goldstein – to take me to task for suggesting that lobbying ought to be abolished.

And Barry Passett – who was a lot closer to the events in question than I was – pointed out that I misstated the reason that the Clinton’s reform effort was killed, and in doing so over-simplified the issue.

I wanted to put my clarifications into a post rather than a comment, to give them the attention they deserve. And I’ve revised yesterday’s post to reflect the corrections.

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The Changes We Need

These are, as the Chinese curse reputedly called them, interesting times.

If the burst of new Democratic health care reform proposals is any indication, a fresh breeze of the Obama campaign’s "Yes We Can" optimism is blowing across the nation. Mr. Obama’s team is expected to make health care one of its priorities. First out, though, was Senate Finance Committee Chair Baucus (D-MT), who introduced an aggressive health care reform package that builds on Mr. Obama’s campaign platform of cost controls and extended coverage. Senator Kennedy (D-MA) and Representatives Dingell (D-MI) and Stark (D-CA) are expected to offer proposals soon, and undoubtedly there will be others.

The rub is that Congress’ old-guard lobbying system remains in place. Congress is awash in special interest contributions – $2.8 billion from 15,500 lobbyists in 2007 – that exchange money for influence over policy. When the Democrats retook Congress two years ago, they did not substantively change the lobbying rules.

So it is reasonable to ask whether a new day of governance in the common interest is possible. Can we make progress on health care or on any significant problem – climate change, education, energy policy, finance, the social safety net – without addressing the underlying problem of Congress’ receptiveness to special interest influence?

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Can Health Plans Explain Why They Aren’t Re-Empowering Primary Care?

Mh_counseling

Sometimes a whisper is more powerful than a shout. Here’s a cartoon from Modern Medicine that shows a Medical Home counseling session between a primary care physician (PCP), a specialist and the health plan. The PCP looks forlorn, while the specialist and the insurer have their backs turned, fuming. It is perfectly true.

Along with changing the way we pay for all health care and creating far greater pricing and performance transparency, we need to turn around the primary care crisis if we hope to substantively improve quality and cost.

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An Impending Hanging: Will Health 2.0 Be Compromised By The Economic Downturn?

Nothing focuses the mind like an impending hanging. — Samuel JohnsonBrianklepper_2

I’ve been preparing for tomorrow’s 3rd Health 2.0 conference in San Francisco, where I’ll join my pals Matthew, Indu Subaiya, Jane Sarasohn-Kahn and Michael Millenson amid a Who’s-Who cast of health industry luminaries. I spent part of Monday reviewing the attendee and sponsor lists, impressive indeed, testament to how seriously this topic is being taken throughout health care.

The meeting is sold out at 950 participants. It’s worth remembering that, before the first Health 2.0 conference 13 months ago, Matthew, who with Indu took enormous professional and personal financial risk to pull this off, told me he’d be surprised if 75 people showed up. There were almost 500, many of them with genuine influence.

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Health Care and the Broader Economic Crisis

Over at HealthLeaders, Dr. Richard Reece and I have an article, Will Primary Care Be Re-Empowered By An Ailing Economy?, arguing that the turmoil in the larger US economy – and particularly the tightening of credit – is going to significantly enhance the pressures on purchasers and industry players, and grease the wheels of meaningful change throughout health care.

Consider, for example, the fact that most hospitals and health systems
have remained in the black only as a result of investment income. Many
lose money on operations. How will health systems remain afloat if the
returns on their investments are diminished?

Then there was the Wall Street Journal story
a couple weeks ago in which Vanessa Fuhrmans described significant
drops in office visits, filled prescriptions, elective surgeries as
consumers cope with the economic downturn. That was before the big
crashes that began a few weeks ago.

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Chastened and More Sober, Harry and Louise Return

On Tuesday, Ron Pollack of Families USA led a call with bloggers — unfortunately, I couldn’t be on it — to discuss  Harry and Louise Return — the new health reform campaign sponsored by five prominent organizations: the American Cancer Society’s Cancer Action Network (ASC CAN), the American Hospital Association (AHA), the Catholic Health Association (ACHA), Families USA and the National Federation of Independent Business (NFIB).

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