Tag: Policy

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

Jul 1, 2008• 5

By David Kibbe

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.

NY Times examines CT scans and evidenced-based medicine

Jun 30, 2008• 5

By Merrill Goozner

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

Markle promotes a privacy standard

Jun 26, 2008• 1

By Matthew Holt

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.

Check the WSJ opinion section for more BS on Medicare Advantage

Jun 26, 2008• 2

By Matthew Holt

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?

From the AHIP fields….

Jun 20, 2008• 3

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!

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)

Interest groups clash over doctor-owned specialty hospitals

Jun 17, 2008• 2

By Donald Johnson

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.

State regulators challenge the rights to your DNA

Jun 16, 2008• 11

By Matthew Holt

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?

Health costs are small businesses’ No. 1 problem

Jun 15, 2008• 3

By Jane Sarasohn-Kahn

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.

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.

The Long Baby Boom

Jun 8, 2008

By Matthew Holt

Last Friday I had a great chat with healthcare futurist Jeff Goldsmith about his new book, the Long Baby Boom. We discussed the policy and cultural issues of retirement, Medicare, Social Security, immigration, end-of-life care and meaning in work. With 76 million baby boomers heading towards age 65, these issues or of great importance.

Here’s the interview.

CBO assesses return on investment of HIT

May 30, 2008• 2

By Jane Sarasohn-Kahn

The return on investment of health care information technology isn’t uniformly positive, according to a recent analysis from the Congressional Budget Office titled, Evidence on the Costs and Benefits of Health Information Technology.

The underlying rationale for the report, which was requested by the Senate Budget Committee, is to sort out the federal government’s role in health IT. The report asks, "Whether — and if the answer is yes, how — the federal government should stimulate and guide the adoption of health IT."

The federal government is already in the health care IT fray. President Bush set the goal in 2004 that every American have an electronic health record by 2014. This was a vision, however, without a funding source. There are also several proposals in Congress that would expand the federal government’s role in health IT by mandating the use of electronic prescribing, provide financial incentives to providers who use health IT, and offer grants to purchase systems for providers.

The CBO report points out a major benefit of health IT that has been largely overlooked: IT’s role in research on the comparative effectiveness of medical treatments and practices. When individuals’ health data is in electronic format, it can be depersonalized, aggregated, and analyzed for a range of uses, such as medical effectiveness, quality, and system efficiency, among other research questions.

One sentence in the 48-page report encapsulates the Mother of All Barriers to Health IT Adoption: "How well health IT lives up to its potential depends in part on how effectively financial incentives can be realigned to encourage the optimal use of the technology’s capabilities."