By Val JONES MD

Rumor has it that Sanjay Gupta
is no longer in the running for the office of Surgeon General. Many
peopl
e had voiced their concerns about his potential nomination
(including Paul Krugman, Maggie Mahar, Gary Schwitzer, Dr. David Gorski, and myself)
and it looks as if his lack of experience or training in matters of
public health, along with a history of industry ties has put the kabosh
on his nomination.

So who will be our next Surgeon General? It’s hard to say, but a petition is circulating on behalf of Dr. George Lundberg – a fine nominee for the position in my opinion. Let me explain why.

A review of Dr. Lundberg’s curriculum vitae easily
establishes his professional qualifications for the position. Not only
has he been one of the longest standing Editors-In-Chief of all the
American Medical Association journals (including JAMA), and the founder of the world’s first open-access, peer reviewed online medical journal (Medscape Journal of Medicine)
but has served in an advisory capacity to everyone from the World
Health Organization, to AHRQ, the Joint Commission, Harvard’s School of
Public Health, the Department of Health and Human Services, Food and
Drug Administration and the Surgeon General of the US Navy. He is also
a prolific and influential writer, having authored 149 peer-reviewed
articles, 204 editorials, and 39 books or book chapters. Dr. Lundberg
has a large and devoted national and international audience and is
highly esteemed by all who know him.

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By Val Jones MD

Pretty much everyone agrees that we need to improve the quality of healthcare delivered to patients. We’ve all heard the frightening statistics
from the Institute of Medicine about medical error rates – that as many
as 98,000 patients die each year as a result of them – and we also know
that the US spends about 33% more than most industrialized country on healthcare, without substantial improvements in outcomes.

However, a large number of quality improvement initiatives rely on
additional rules, regulations, and penalties to inspire change (for
example, decreasing Medicare payments to hospitals with higher
readmission rates, and decreasing provider compensation based on quality indicators).
Not only am I skeptical about this stick vs. carrot strategy, but I
think it will further demoralize providers, pit key stakeholders
against one another, and cause people to spend their energy figuring
out how to game the system than do the right thing for patients.

There is a carrot approach that could theoretically result in a $757
billion savings/year that has not been fully explored – and I suggest
that we take a look at it before we “release the hounds” on hospitals
and providers in an attempt to improve healthcare quality.

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By JOHN HALAMKA

Today, according to the Associated Press and Washington Post, President
Obama will announce 
Kathleen Sebelius as his nominee for Secretary of
Health and Human Services. She has a once in a lifetime opportunity to
execute healthcare reform – a popular President, a sense of urgency,
and enough resources to get the job done. What are these resources?

You'll find the Office of Management and Budget FY2010 Budget Overview Document online The full FY2010 Budget is expected to be released this Spring.

Highlights from the Healthcare portion of the overview document include:

*
A reserve fund of more than $630 billion over 10 years to finance
fundamental reform of our health care system, funded half by new
revenue and half by savings proposals that promote efficiency and
accountability, align incentives for quality, and encourage shared
responsibility. Examples of new revenue include a proposal that
individuals earning more than $85,000 pay higher premiums for their
Medicare drug coverage starting in 2011. Examples of savings include a
revision of payments to insurers that provide Medicare Advantage plans.
Those payments have been on average 14% higher than what the government
typically spends per beneficiary. Under the budget proposal, insurers
would be required to competitively bid to offer plans beginning in
2012, which the administration believes would lower per-patient outlays.

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What’s fair in managed care? Get involved. Join the conversation. FAIR
is an emerging national grassroots movement focused on changing the
debate about health care costs and holding managed care companies
responsible for their behavior.  Supported by patients, hospitals,
physicians, business owners and policy makers, FAIR brings a unified
voice to the table at the peak of a national discussion on health care
reform.

By Matthew Holt

And although the fuss about CCHIT’s corporate issues seems to have been more or less settled, there are still some real questions about the inter-relationships between HIMSS, CCHIT and EVRA.

And frankly it doesn’t really help un-muddy the waters when HIMSS comes out with a guide for providers on how to spend all that lovely money that the Feds just tossed your way as though they’re a neutral body.

They call it the HIMSS Online Buyer's Guide. It’s actually a guide to companies that are exhibiting at HIMSS; or for a mere $395 a year you too can buy an ad in it. Now I know it’s a service from a company that runs conferences, publications and consulting. And given that’s something I do too in a much smaller way I have no problem with them doing that.

But given the influence HIMSS peddles on behalf of (mostly big) vendors, and the real concerns over the neutrality of CCHIT, perhaps they could change their terminology to make it a little more transparent about what this “Buyer’s Guide” actually is—a list of advertisers and vendors, not a neutral publication from a organization that only has providers & buyers at heart.

By JANE SARASOHN-KAHN

The most telling point about health reform in President Obama's budget is that, "Some researchers 
believe that healthcare costs could be reduced by a stunning 30 percent — or about $700 billion a year — without harming quality if we moved as a nation toward the proven and successful practices adopted by the lower-cost areas and hospitals."

That sentence gives us some grist for forecasting some of the elements of health reform — in particular, the last phrase which talks about moving from higher-cost, unproven health practices to lower-cost proven approaches.

In a post earlier this week, I talked about the importance of understanding practice variations, especially those behaviors that lead to increasing costs without improving health outcomes. Under the New England Journal of Medicine paper's scenario, all practitioners would be incentivized to behave as if they practiced in Salem, Oregon and not Miami, Florida.

What will it take to "move" medical practices? We can take a page out of Costco's playbook to answer this one. Three Costco tactics which keep the business resilient will be relevant to this scenario: standardization, deployment of information technology, and tough negotiations with suppliers.

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By MAGGIE MAHAR

Earlier this week, I suggested that the Commonwealth Fund’s recent proposal for healthcare reform  underlines just how difficult it will be to build a sustainable, effective, safe healthcare program for all Americans.

President Obama’s budget reinforces the message. His ten-year $634-billion plan for funding healthcare reform depends on “asking the wealthy to pitch in a bit more” (budget director Peter Orszag’s happy phrase), wringing some of the waste out of Medicare and Medicaid (cuts that are needed, but that will not be popular ); and strong-arming drug makers to raise discounts on Medicare drugs from 15 percent to 21 percent. About half of the money will come from changes in government programs, half from tax increases.

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By ROBERT LASZEWSKI

The President has made a powerful argument— America cannot get its economic house under control without comprehensive health care reform. The cost of existing entitlements – public and private —and any new ones are just too big a ball and chain on our short and long-term economic health.

The
President has also argued that there could be no better time to fix
this mess than now—when it is so critical to get our economic house in
order once and for all.

The President is right on both counts.

As any of us who have studied this issue know, the number of those uninsured in America are not really the problem—they are a symptom of health care costs
run amuck as individuals, employers, and government just can’t afford
to insure everyone. Adding more people to this unaffordable mess
without fixing it first is not an answer—it’s a prescription for even
more fiscal irresponsibility.

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