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POLICY: Health Care Reform Now? Don’t Hold Your Breath

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While Brian goes into the details of what’s need for reform, it just so happens that a few weeks back I wrote an op-ed for the LA Times suggesting that the current “crisis” wasn’t bad enough. As (after soliciting the darn thing) they didn’t print it, I thought it was time to give it an airing and I’ve put up a version of it as my Spot-on piece for this week. It’s called Health Care Now? Don’t Hold Your Breath.

Judging by the number of articles about corporations, unions and politicians decrying America’s healthcare system, you could be excused for believing that we will have health care reform very soon. You’d be wrong. More

Reform’s Tougher Problem by Brian Klepper

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Yesterday, Matthew gracefully pointed to my post over at Bob Laszewski’s Health Care Policy and Marketplace Review, which I called "The Tougher Health Care Problem." Bob’s readership leans heavily toward the DC-based health care policy types who may not follow the happenings over here. The policy crowd is a slightly different but very important audience that I hoped might be receptive to a different message than they are typically pitched.

Reform is a complicated topic, particularly because the discussion tends to be so narrowly defined around its objectives: access, quality and cost. But an equally important issue is that American health care is fundamentally about power and money. Achieving reform requires a real understanding of the power dynamics involved.

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POLICY: Nanotechnology and the Regulation of New Technologies by Bart Mongoven

Bart Mongoven is a senior analyst with Austin based strategic intelligence consultancy  Stratfor.com, where he tracks public policy. This piece first appeared in the Stratfor Public Policy Intelligence Report. If you find his analysis interesting, you may want to take a look at his earlier analysis of the issues facing California Gov. Arnold Schwarzenegger’s health reform plan. You also may want to consider signing up for their free email reports, which I find very useful and well-informed.  — John 

Researchers from the Woods Hole Oceanographic Institution and Massachusetts Institute of Technology on Aug. 16 released a study stating that the production of carbon nanotubes gives rise to the creation of a slew of dangerous chemicals known as polycyclic aromatic hydrocarbons, including some that are toxic.
Discussion of a new regulatory regime for nanotechnology has been ongoing among think tanks, advocacy groups and industry for years, and findings that suggest the sector could generate public health risks will add to the growing pressure on regulators or legislators to decide how to regulate it.

The debate over the regulation of nanotechnology has taken place on two levels. The first is over the public health risks nanotechnology poses and ways to determine and measure those risks. This is mainly the familiar risk-assessment process applied to the products of a technology that acts slightly differently than previous technologies do.
At the center of a second debate over public policies governing nanotechnology is an older, more contentious issue: the politicization of science and technology.

At issue is the point at which government is justified in stepping into the realm of science to stop or slow scientific research, regardless of whether harm has been done. This concern lay at the center of the early debate over biotechnology, and also played a role in the debate over federal funding of stem cells and bans on human cloning.

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HEALTH PLANS: Who said this? No, really

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But if you take five people who didn’t get coverage through their employer or were self-employed and you ask them, ‘What’s the No. 1 thing that keeps you awake at night?’ I think a large percentage would say health care. What we’re trying to do is create a better environment for the consumer, the provider and the payer. To all work together.

One very scummy company is launching a PR offensive. I’m sure there are plenty of people who’ve bought HealthMarket’s quasi-fraudulent products who aren’t sleeping too well at night.

POLICY: Klepper, moonlighting again!

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Just when we thought we had him pinned down, Brian is moonlighting over at Bob L’s blog. His piece is called Solving the Access Problem Isn’t Enough If We Don’t Deal With Costs. Not absolutely true in my view. I think you need to do access first then deal with costs. He thinks you need to do them both together. But we’re both sensible enough to think that they’re both problems, and plenty of people—whether at Cato or at Harvard—disagree.

Another Step Toward Transparency — Brian Klepper

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It was the great economist Adam Smith who said that, for markets to work, they need (among other things) "perfect information." Health care hasn’t worked, in large measure, because its markets have had almost no information.

So in what could be a huge step forward for the health care transparency movement, a federal court has ruled that the public interest outweighs concerns about physician privacy, and that, next month, CMS should release to a consumer advocacy group the Medicare data sets for 4 states and the District of Columbia. Here’s a snippet from Saturday’s Wall Street Journal article (subscription required):

The data at issue include medical-procedure and
billing details that physicians send to Medicare to get reimbursed by
the federal insurance program for the elderly and disabled. Although
collected largely for billing and administrative purposes, the data
could be analyzed to see how often a doctor performs a given procedure
and even to compare mortality rates among patients of different doctors.

The government has until Sept. 21 to release the data,
covering Maryland, Illinois, Washington state, Virginia and Washington
D.C., to the nonprofit Consumer’s CHECKBOOK/Center for the Study of
Services. The group said it will set up a free database on its Web site
for public use. It has filed similar public-information requests for
Medicare claims data for all 50 states.

It’s worth noting that this Administration, which has prided itself on its advocacy for EMRs, transparency, RHIOs and all the rest of it, when it counted, sided with keeping doctor performance secret. When the chips were down, this is how it actually worked.

You can bet that analytical groups all over the country will pounce on this information, profile and post the performance of physicians in these states, and campaign for access to the rest of the data.

Until recently, despite a lot of very worthwhile effort, data that could be used to develop performance information have been scarce. Health plans, who had the largest health care data sets, weren’t forthcoming with them. Now they’re publishing pricing data, which are somewhat useful, but not as useful as some of the other information embedded in their repositories.

The importance of this case can’t be overstated. The release of the Medicare data, if it happens, will go far toward making physician performance data more available and commonplace. This is a major victory for health care reformers, and many thanks go to Consumer’s CHECKBOOK, the advocacy group that sued for the data. It’s still too early to break open the champagne, of course, because the powers that oppose transparency still have a month to get the decision reversed.

Read the court’s opinion here, and CHECKBOOK’s press release here. This is just one more brick in the wall, of course. But there’s steady progress. It’s happening. And everything will eventually change in health care as a result.

PHARMA/QUALITY: Merrill Goozner has dug into “The Most Costly Earmark in S-CHIP”

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GoozNews: The Most Costly Earmark in S-CHIP

Increased risk of death. No benefit. Higher costs for taxpayers. The ongoing Epo saga, whose latest chapter is being written on Capitol Hill, is a perfect example of why our health care outcomes are second-rate, while our health care costs are second to none.

This is a great bit of digging from Merrill, and it shows why FFS or in this case, Fee for drugs is just a bad way of paying for medical care. Do read it.

What Are They Thinking: ONCHIT and RTI – Brian Klepper

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I’m sure I don’t really get the deeper issues involved here, but sometimes its hard to not have your breath taken away by some people’s notion of a good idea. Maybe its because I’m not a true geek, but what I’m about to describe strikes me about the same way I feel as when I see a young adult with multiple facial piercings and hear her/him say "Aren’t these great!?"

Modern Healthcare has an interesting piece on a report that was developed by RTI, a contractor to HHS’ Office of the National Coordinator for Health Information Technology (ONCHIT). The report urges revising Electronic Medical Records (EMR) standards to make it easier for payers and the feds to access the records and spot  fraud.

Now I’m as big a transparency advocate as the next guy, and I routinely explain to doctors how claims or clinical encounter data can be used to accurately rate their pricing and performance relative to peers within specialty. I believe we should use performance ratings to reward the high performers and to incent the poor ones to do better.

But to really get to the system we need, doctors first have to implement and use EMRs. They’re key to making the health system as a whole work better. Fewer than a quarter of physicians currently use them at this point. While there are still some buggy whip advocates out there, a large and growing number of doctors get that. Young physicians take it for granted.

Still, there are a lot of hurdles to installing an EMR system. They’re expensive. They force you to change your practice’s work flows. Some of the designs aren’t all that friendly. They’re complicated. And who wants to learn a new system. Heck, I know I’d like what it can do for me, but I haven’t gotten up the nerve to tackle iMovie yet on my Mac, and that’s about a tenth as complicated as an EMR with embedded practice guidelines.

We KNOW EMRs are a good idea but there are lots of reasons for doctors to say NOT YET. This Administration, to its credit (he said, grudgingly) has gloried in their advocacy for these new
technologies, what they can do, and how they can help improve quality and cost. (Remember Newt’s
line, "Paper Kills?")

So WHY would the guys leading the charge on EMRs announce that one of the really great things to use EMRs for when doctors finally bring them online is to WATCH AND CONTROL THEM MORE EFFECTIVELY.

Dumb, dumb, dumb.

But I’m sure I don’t see the big picture here.

Evaluating the Quality of Quality Improvement Claims: The Population Health Impact Institute – Brian Klepper

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Thomas Wilson PhD is on a mission that’s important to health care. Tom, a respected epidemiologist particularly well-known in disease management circles, founded the Population Health Impact Institute (PHII), a not-for-profit devoted to establishing clear, objective rules to evaluate claims of financial and clinical improvement associated with health management programs.

In an August 16th press release, PHII announced its intention to develop a new accreditation program that

“will focus on the methods behind the claims.  It will be based on the established evaluation principles of transparency and scientific validity successfully used by the PHII since its founding in 2004:

  • Transparency of metrics,
  • Equivalence of populations,
  • Statistical significance of measures,
  • Plausibility of hypotheses, and
  • Disclosures of potential conflicts-of-interest.”

This isn’t a lightweight effort. To oversee the development of their "Quality Evaluation Process” (QEP) standards will be developed by a volunteer panel of national experts, and chaired by former URAC President and CEO Garry Carneal, who oversaw the development of 16 new accreditation programs during his tenure with that quality accreditation organization.

PHII also boasts the participation and support of Sean Sullivan, the CEO of the not-for-profit large employer group, The Institute for Health and Productivity Management. Sean has been an extremely balanced and important voice on health care reform. His group argues that it is in employers’ interests to stabilize and improve health care quality and costs, because employees and families with good health care produce are far more productive. The opposite is true as well.

PHII is looking for expert volunteers for its standards panel. Visit the site of this important effort and consider whether you or your organization might have a way to contribute expertise, financial resources or both.

By way of disclosure, I sit on PHII’s Steering Committee.

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