Tag: Policy/Politics

Disgusting, and another reason why marriage needs to be re-defined

May 18, 2009• 9

By Matthew Holt

Tara Parker-Pope reveals two cases where discrimination kept a partner, and in one case the dying woman’s children, away from their loved one while they were dying in hospital.

One hospital involved is Jackson Memorial in Miami, a massive recipient of Federal dollars. In 1965 then un-integrated hospitals in the south were forced by the Federal government to take black patients as part of the new Medicare program. It’s high time that an executive order was made by Obama that hospitals receiving Federal dollars immediately change their visitation policies in this respect.

But beyond that, those bigots (including the ones who have commented on THCB) who continue to maintain that not changing the legal definition of marriage doesn’t hurt anyone should consider the stories of the people Tara reports about, and they should feel very guilty.

Connecting finance to coverage

May 15, 2009• 20

By Matthew Holt

Repeating his message that Health Costs Are the Real Deficit Threat OMB Director Peter Orszag goes into the not exactly friendly territory of the WSJ Opinion pages and explains that practice variation is unnecessary and wasteful, comparative effectiveness research is a good idea. and that changing financial incentives for providers is necessary if we are ever to get health care costs under control.

The question is, how much of this gets included in the woffling coming out of Sen Max Baucus’ Senate Finance Committee? Here’s the press release on the options they’re considering. It’s a little like Stalin in 1930 saying, ‘the people are starving, we may collectivize the Kulaks, or we may rent them their farms back, or we may do nothing, or all of the above”. OK you may think I’m kidding but they give four different options for what a public plan may look like, six different approaches to small group and individual market reform (none of which deal with the smallest employers), and nothing about Orzsag’s concept of “changing financial incentives for providers”. Apparently that’s unrelated to insurance reform. (Yes yes I know they’ve floated some trial balloons about that too….)

What worries me is that because of the downturn and Orszag shining the light on the finance issue, we may have the chance to both fix coverage and finance. But I don’t see this all happening together.

So far I haven’t seen anything to change my mind about what’s going to come out of this process. So to bore all of you still reading I’m going to repeat what I said when I reviewed Tom Daschle’s (remember him?) book Critical.

So my guess is that the Federal Health Board, if it gets established, will get defanged by lobbyists immediately. The consequence of that is that the mish-mash of an “expand what we got now” system will cover a few more people at a lot more cost (as has been the Massachusetts experience). That’s OK because suddenly we’re rich (or at least suddenly the government is pretending it is!). But in a few years the stimulus will end and health care costs will have kept going up. Then we’ll realize that due to more cuts in Medicaid & subsidies for the working poor, and continued cream skimming and bad behavior by private-sector health plans, enough people have fallen through the cracks of the incremental expansion that we’ll be back where we are today again.

CODA: Click here to have some fun as to what happened when Baucus lined up 13 Democratic economists to talk about health care to his Committee and somehow couldn’t find even one who was in favor of single payer…

An Open Letter to the New National Coordinator for Health IT: Part 3 — Certification As The Elephant in Health IT’s Living Room

May 8, 2009• 22

By DAVID C. KIBBE and BRIAN KLEPPER

6a00d8341c909d53ef01157012476e970b-pi In the first and second parts of this series we talked about how and why there is no universal definition for the term “EHR.” Instead there is a legitimate, growing debate about the features and functions that “EHR technologies” should offer physicians seeking to qualify for HITECH incentive payments. We explored the layers of network technology, suggesting that federal regulators should “separate the data from the applications.”

We also argued that there is much to learn from development platforms, recently and in the distant past, that have used standards to open the aperture of innovation. The best of these standards have reflected the experience of what works rather than specifying how to make it work. Defining the standards for data, devices, and network technologies too restrictively could choke off innovation, rendering HITECH’s offerings whose expense and complexity are a barrier to, rather than an incentive for, adoption by physicians. Incoming National Coordinator for HIT David Blumenthal, MD seems to have been considering just this concern when he recently wrote:“… [M]any certified EHRs are neither user-friendly nor designed to meet HITECH’s ambitious goal of improving quality and efficiency in the health care system. Tightening the certification process is a critical early challenge for ONCHIT.”

The Health IT Stimulus and FQHCs — Don’t Forget About Us!

May 7, 2009• 5

By JAMES KAHN

James Kahn There is a critical element in the American Recovery and Reinvestment Act (ARRA) that targets funds for Federally-Qualified Community Health Centers (FQHCs). An FQHC is an organization defined by the Medicare and Medicaid statutes that receives funding under Section 330 of the Public Health Service Act. FQHCs provide primary care services for all age groups and provide preventive health services on site to some of the country's most vulnerable populations, and they are an important part of this country's primary care delivery system. Among services that FQHCs must provide directly (or by arrangement with another provider) include: dental services, mental health and substance abuse services, transportation services necessary for adequate patient care, hospital and specialty care. There are more than 16 million Americans who are served by FQHCs.

Where’s THCB’s share of the money? Or does Stuart Browning feel left out?

Apr 27, 2009• 6

By Matthew Holt

My lefty friends at Moveon.org emailed me (and a few million others) appalled that Rick Scott’s group is going to be spending $1 million running ads attacking the as yet officially non-existent Baucus/Daschle/deParle/Obama health plan. Now that’s not exactly a surprise. Rick Scott has been on the offensive for a while now and in the spirit of inclusiveness (or the more cynical among you might say, to start a fight in an empty house) THCB ran his op-ed a while back. Frankly it was pretty tough to figure out what he was “for” but it’s clear what he’s against—the evils of Canada and the UK.

Yesterday I had a little fun teasing some Norwegians over here to learn about the US health care system. I asked them what they wanted to learn about, and one of them said “what about the 48 million uninsured”. I told her that Americans were a kind and generous people, and that there couldn’t possibly be anyone here uninsured or suffering because of it, and obviously the two Michael’s at Cato and the nutjob prof at Harvard prove me right about uninsurance being a) voluntary and b) the fault of three Medicaid clerks in New York state who forgot to print the enrollment forms in Spanish. OK, OK, I changed my tune a little a few seconds later.

But that remains basically the screed of the Canada bashers. They say that those evil Stalinists in the UK and Canada are the same (even though they’re not), and no one gets any care. Whereas here it’s all sweetness light, teddy bears, puppies and all the MRIs you can eat.

However, I am beginning to tentatively that the lack of mainstream industry support for Rick Scott signals a couple of things—besides the fact that the mainstream is somewhat nervous of being led by a~~n unconvicted fraudster~~ man whose company settled with the government for $1.7 billion after it fired him.

An Open Letter to the New National Coordinator for Health IT – Untying HITECH’s Gordian Knot: Part 1

Apr 26, 2009• 19

By DAVID C. KIBBE & BRIAN KLEPPER

KibbeB&Wjpg Congratulations to David Blumenthal on being named National Coordinator for Health Information Technology (ONCHIT). Dr. Blumenthal will be the person most responsible for the rules and distribution of the American Recovery and Reinvestment Act’s (ARRA) nearly $20 billion allocation, referred to as HITECH, designated to support physician and hospital adoption of health information technologies that can improve care.

The job is fraught with difficulties, which Dr. Blumenthal has readily acknowledged. His recent New England Journal of Medicine (NEJM) Perspective, “Stimulating the Adoption of Health Information Technology,” is a concise, clear and honest appraisal of two of these challenges, namely how to interpret and act upon the key terms used in the legislation, “meaningful use” and “certified EHR technology.” Dr. Blumenthal gets to the heart of the matter by identifying the tasks on which the National Coordinator’s success will most depend, and which will foster the greatest controversy.

The country needs Dr. Blumenthal to succeed. The issues are complex and, with huge ideological and financial stakes involved, politically charged.

An Open Letter to the New National Coordinator for Health IT: Part 2 – Opening the Aperture of Innovation

Apr 22, 2009• 21

By DAVID C. KIBBE & BRIAN KLEPPER

6a00d8341c909d53ef01157012476e970b-pi

One of the important decisions before Dr. Blumenthal and his colleagues at ONC and HHS is whether the national health information network will be one of closed appliances that bundle together proprietary hardware, software, and networking technology, or one of open data exchange and management platforms in which the component parts required to do medical computing can be assembled from different sources. If the former direction is chosen, power and control will be concentrated in the hands of a very few companies. If the latter, we could see an unprecedented burst of disruptive innovation as new products and services are developed to
create the next generation of e-health services in this country.

Separating the data from the devices and applications, and maintaining a certain degree of independence of both from the networks used for transmission, is far more than a technical quibble. It can determine the economics of technology in stunning ways.

The Public Plan–Mutual Assured Destruction?

Apr 20, 2009• 7

By ROBERT LASZEWSKI

I typically don’t talk about my travels on this blog but something happened this week that bears reporting.

Whether
the federal government should or should not offer a public health plan
alternative to compete with private insurers in the under-age-65 market
is a hot topic in Washington and in the market.

I recently posted on it in detail: The Public Plan Option for the Under-Age-65 Market—The Biggest Health Care Controversy on the HillThis
past week I met separately with two health insurance CEOs—both
well-known leaders in the business and both from highly regarded
not-for-profit plans.

Herzlinger–Enthoven was right all along

Apr 13, 2009• 3

By Matthew Holt

In a blog piece called Why Republicans Should Back Universal Health Care Regina Herzlinger says something that I more or less agree with. Switzerland’s system isn’t a bad option. Neither for that matter is Holland’s. Now of course Maggie Mahar has debunked Herzlinger’s notion that there isn’t state regulation of insures and providers in those systems. And Regi also talks a lot of tosh about Medicare, the UK and the evils of the government in the same piece. But I guess she feels she has to do that to keep whatever’s left of her audience (that would be the four Republicans who care about health care, rather than the health care business types who have moved on in pursuit of who now holds the purse strings).

But I’m just left with one little question. Where’s Herzlinger’s mea culpa to Alain Enthoven? After all he’s been promoting the Dutch answer (he basically designed it) since 1978 or thereabouts. And I don’t recall Herzlinger mentioning that in the numerous times she’s been slamming managed competition and its father.

Cats and dogs on film–Tullman, Leavitt, Bush

Apr 13, 2009• 2

By Matthew Holt

Anyone who’s been following along on THCB will realize that there’s a huge divide about whether the HITECH act should pay for and dictate a specified, certified type of EMR product use OR pay for data and outcomes and not specify how providers get there. The “cats” support certification and EMR mandating (more or less). The “dogs” think that existing EMRs are often counterproductive and that a mix of other data sources, processes, and patient outreach technologies will get us where we need to in terms of improving outcomes much quicker. And now there’s an extra $20 billion in the mix, just to add some fun.

Rather than write more about that at HIMSS this week I got detailed interviews on film with leading “cats”, Glen Tullman, CEO of Allscripts, and Mark Leavitt, Chair of CCHIT. And then a response from the always highly caffinated dog-lover Jonathan Bush, CEO of AthenaHealth. And no, they don’t agree with each other…..although there is some common ground.

If you’re at all interested in how Health IT & EMRs will play out, these three are must-sees. (I’d view them in the order I took them).

MH Interview with CCHIT head Mark Leavitt. (24:51)

MH Interview with AthenaHealth CEO Jon Bush (23:29)