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Tag: Policy

Consumer genetic movement: Cease and desist? How about understand and resist!

I have been following health care consumerism for several years now. Particularly, the “Direct Access” or “Direct To Consumer” laboratory testing market. While analytic lab testing has led out in this area, genetic testing has received all the regulatory attention, national press, and policy efforts (GINA).So it is no surprise that consumer genetic movement would be the first legal test of the Health 2.0 movement. As reported by Matthew Holt here on THCB, and a host of national outlets (Wired has had extensive coverage here, here, and here), there seems to be quite a hornets nest unleashed by our friends at the California and New York Departments of Health who are attempting to prevent consumers from accessing their own genetic information.

Thanks to some transparency efforts of the blogosphere, you can read the actual cease and desist letter written by Karen Nickels, the California Department of Pubic Health Chief of Laboratory Field Services. I actually know Karen Nickels personally. She has been a long time steward of ensuring regulatory exactness of all things laboratory within the State of California for 30+ years. She has a well deserved reputation as one tough cookie for the “precision” with which she carries out her dutiesUltimate Genetic Fighting – Which Genetic Variation Wins?

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Docs get mad, 2.0 style, at Sermo

SermoOf course, it’s not just cornering a Senator at July 4th picnic that changes policy.
These days there are online communities doing it too. And with increased grumpiness among many doctors, and now the almost-here-rather-than-looming-on-the-horizon cuts in Medicare, you can expect a response online. And here it is: Fed up Sermo docs draft manifesto. Yup, those docs hanging out on Sermo are not just discussing clinical cases, they’re on the verge of getting politically active. As you might expect, they’re pissed off with insurers, the government and lawyers. And who could disagree? (I know, I know it’s more complex than that….)

Never one to miss a trick, Sermo has allowed itself to be used as a vehicle for the open letter that’s going to get much more publicity (and yup, as a doc you have to sign up for Sermo to sign the letter, to verify that you are a doc!). Here’s the site called Doctors Unite.

Every other form of political activism has moved online, so don’t be surprised to see more like this. Of course, if the details get specific, it’s tricky to know whether the coalition of pissed off docs will hang together, and also whether Sermo will become type-cast as representing a particular flavor of doctor (see: Medical Association, American) which may somewhere down the road limit its business initiatives. But for now, it’s fun to see online organization get serious in health care.

The Feds’ strange love-hate relationship with health IT policy

With less than loud fanfare — barely a peep, really — the Office of the National Coordinator for Health IT (ONC) finally last week released its ONC-Coordinated Federal Health Information Technology Strategic Plan.

The plan is more than two years overdue and came only after scolding from a Government Accountability Office report in 2006 and an internal, semi-secret review of ONC’s doings by the Institute of Medicine late in 2007. The IOM criticized ONC for the lack of a viable strategic road map almost four years after President Bush’s call for interoperable health information technology and personal health records. A lot has happened since 2004 in this area, though you’d hardly know it reading the ONC Plan.

ONC is a top-down, heavily bureaucratic,
large-medical-enterprise-centric, and large-IT-vendor-led juggernaut
that has always been out of touch with what goes on down on the ground
where consumers, patients, nurses, and primary care doctors live and
work.

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NY Times examines CT scans and evidenced-based medicine

The front page of the New York Times Sunday morning had a don’t miss article on the financial incentives behind using CT scans to look for heart disease. Medicare’s decided in March to begin paying for the test despite no evidence that it saves lives (see this GoozNews post). The lobbying campaign by a newly created physicians guild that invests in CT scanning clinics is discussed in the last few paragraphs of the story. That campaign was aided by "entrepreneurial guidelines" touting the procedure, discussed in this GoozNews post.

Here are the two key quotes from the story:

"It’s incumbent on the community to dispense with the need for evidence-based medicine." –Dr. Harvey Hecht, Manhattan cardiologist and CT scan advocate

"There are a lot of technologies, services and treatments that have not been unequivocally shown to improve health outcomes in a definitive manner."–Dr. Barry Straube, chief medical officer, Medicare

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Markle promotes a privacy standard

The Markle Foundation put together a group creating a road map over the last few years and today they announced their new policy framework for privacy in PHRs and personal health information. In general this is a great framework, and hopefully will help gain more consumer confidence in PHRs and other uses of personal health information online by consumers and doctors. (The AMA was on the call and was a “supporter” if not an “endorser”).

Overall I’m not sure that privacy is that big a deal (as I’ve written elsewhere). Given the choice between being private and being useful, most people pick useful. (You’ll give out your Social Security Number to just about anyone to make a credit check). So I think that PHR and consumer online services need to be useful first. It was a little telling that when someone asked if this would change any of the PHR vendors actual activity, they all said that they’d been adhering to these processes all along! But there is something to being publicly and loudly transparent about it.

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Check the WSJ opinion section for more BS on Medicare Advantage

Scott Gottlieb, who passes for what the right call a health economist these days, has an opinion piece in the WSJ singing the praises of Medicare Advantage plans.

Anyone reading the article would think that Medicare Advantage plans provide better and cheaper care than the FFS program, showing the triumph of private enterprise over government welfare. And that’s why evil Democrats hate them so much.

Unbelievably, Gottlieb ignores the extra payments Medicare Advantage have received over the standard Medicare program since 2004. Even Karen Ignagni doesn’t do that any more. The AHIP crew has long changed its argument from “we do it better and cheaper” to “we help poor black and Hispanic seniors get better benefits, and the fact that we rake a ton off the top and the taxpayer gets screwed is just the cost of doing business, sorry!” But Gottleib is back in the dark ages. Is this really the best the right can do?

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From the AHIP fields….

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Fun and games were had by all at the America’s Health Insurance Plans
(AHIP) conference yesterday. (BTW Now I have a real journalist working
with me on THCB and she says I have to spell out those acronyms!!)

Outside a couple of thousand single payer advocates noisily demanded a ban on greedy health plans. Now I know that the AMA has a running battle with the insurers (Read Michael Millenson’s hilarious piece about that on THCB yesterday). It’s also the case that certain Democratic Senators have it in for them, although as Bob Laszweski notes, that too is "not quite yet" an issue. But it wasn’t them outside!

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Still it was rather fun going to an event that had
a real rather than a software demo going on!

Now the single payer crowd’s time has not yet come, and there is a chance that the private health insurance industry won’t screw itself into oblivion. (Although my guess is that they’ll be ascendant in 10-15 years)

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Interest groups clash over doctor-owned specialty hospitals

Doctor-owned specialty hospitals deliver better quality of care, are more convenient for physicians and patients and take business away from not-for-profit and investor-owned general acute care hospitals, which have been trying to put them out of business for years.

The NY Times reports on the latest effort by liberal Democrats to take down the for-profit specialty hospitals. The Democrats behind this drive don’t believe in for-profit health care providers even though not-for-profit providers are as profit driven as the investor-owned providers. Most Republicans oppose the effort to restrict the growth of doctor-owned hospitals because they understand that many local hospital markets are dominated by a few institutions and that patients and insurance buyers need more competition among providers to keep costs under control.

This is a battle between the powerful American Medial Association, which supports doctor-owned hospitals, and the American Hospital Association, which represents mostly not-for-profit hospitals and wants to end competition from the doctor-owned specialty hospitals.

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State regulators challenge the rights to your DNA

It is something of a surprise that it popped up this way, but the establishment
challenge to Health 2.0 was going to start somewhere. And it appears to have started with two big states, New York & California ordering 13 companies to stop Gene Testing.

Karen Nickel, from the California Department of Public Health, argues that these companies are operating without a clinical laboratory license in California. The genetic tests have not been validated for clinical utility and accuracy.”

But as those companies are outsourcing the testing anyway, that argument barely holds water. Here’s what Navigenics CEO Mari Baker said Navigenics uses a doctor to transit orders and review results, and it relies on a state-certified lab testing company to do the gene tests.”

So what this really is about, of course, is who has the right to order a test? Is it you or do you have to go through a doctor? Or put another way, is it your DNA or is it the state’s?

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Health costs are small businesses’ No. 1 problem

The cost of health insurance is the No. 1 problem cited by small business owners. Health costs beat gas prices — the No. 2 most severe problem cited by small business, in a March 2008 survey.Smallbusiness

This week, small business leaders convened at the annual National Small Business Summit conference of the National Federation of Independent Business (NFIB).

The report notes the downturn in the economy during the second half of 2007 when the NFIB Small Business Optimism Index dropped to 94.6 in December, the lowest since 2001.

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