The Health Care Blog – Page 654 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

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Medicaid Providers Could Lose Billions if Supreme Court Tosses Health Overhaul Law

Mar 14, 2012• 1

By Matt Barry

On March 26, the U.S. Supreme Court will begin three days of oral arguments on the constitutionality of President Barack Obama’s health-care overhaul law which was signed into law on March 23, 2010.

Most of the attention has been focused on whether the court will reject the individual mandate, a provision that requires individuals to obtain health insurance, and less attention has been paid to the possibility that the entire law could be overturned. If the entire rule is overturned there will be consequences for Medicaid and it will affect health-care providers that do business with state Medicaid programs.

Bloomberg Government released a study today which examines the size and scope of the projected revenue that the Medicaid program will direct to companies doing business in the 27 states that have filed suit over the constitutionality of the overhaul law. It looks at the impact a ruling against the law would have on managed care plans, nursing homes and inpatient hospitals, the top recipients of Medicaid spending, over a five year period, from 2014 to 2018.

The study takes a specific look at the potential impact on health-care providers in Florida and Virginia, the two lead litigant states. The study finds:

Gingrich Adviser Urges States to Implement ObamaCare

Mar 14, 2012• 2

By Michael F. Cannon

State after state is refusing to implement ObamaCare’s health insurance Exchanges. Republican David Merritt hopes they will “grudgingly decide” to change their minds.

Merritt is a health care adviser to Newt Gingrich. He is also a senior adviser at Leavitt Partners. Leavitt Partners is a consulting firm that makes money by helping states implement ObamaCare. In the Daily Caller, Merritt tries to persuade state officials to help implement a law they oppose.

Merritt begins his pro-Exchange argument like so: “Imagine that you’re being required to buy a car.” Would you rather choose that car yourself, he asks, or would you rather the dealer choose the car? Hmm, good question. I choose Option C: wring the neck of whoever is requiring me to buy a car. Not Merritt, though. He counsels states to choose their own “car.”

There are so many problems with this analogy that it’s hard to list them all. First, as Merritt essentially admits, states would be able to choose from such a narrow range of “cars” that it scarcely makes a difference whether they pick their own or let the feds do it. Second, states would only have to pay for their “car” if they pick it out themselves; otherwise, the feds pay for it. So Merritt is literally urging states to volunteer to pay for a “car” when the feds would otherwise hand them one for free. Finally, he says states should select their own “car” even though “no one knows what a federal [car] would look like.” How can Merritt counsel states to choose Option A if he admits he doesn’t even know what Option B is? Wouldn’t the prudent course be to wait and see? Especially since the Obama administration admits it doesn’t have the money to create Exchanges itself?

Merritt’s hypotheticals don’t make his point, either:

The Nonprofit Question

Mar 14, 2012• 4

By David Dranove

I am getting caught up on the news after a couple of weeks away and two stories caught my attention. The first is the ongoing debate about the tax exempt status of Illinois nonprofit hospitals, which has received extensive coverage in the Chicago Tribune. Nonprofits avoid paying most state taxes, notably property taxes. For some nonprofit, the tax exemption could be worth tens of millions of dollars annually.

The question before the state is what they should expect of nonprofits in exchange for tax exemption. The current law requires nonprofits to provide “community benefits” commensurate with their tax savings. The state and the Illinois Hospital Association have been unable to find mutually acceptable language to replace this vague standard. The most draconian approach limits community benefits to charity care. At the other extreme, the IHA (and the Chicago Tribune) largely back a proposal by the Civic Federation that defines community benefits broadly to include losses incurred on Medicare, Medicare, bad debt, and community outreach programs.

A few years ago, I advised the state Attorney General’s office on this issue. I argued for the following conceptual approach: In exchange for tax exemption, nonprofit hospitals should be required to perform a commensurate level of “charitable acts,” which I defined as services and programs for which the hospital expects to lose money. Alternatively, charitable acts are those that investor-owned hospitals would not undertake.

Will Payers be the Business Intelligence Services of the Future?

Mar 14, 2012• 5

By JOHN HALAMKA, MD

What is a payer/insurer?

Typically, payer organizations collect premiums from employers and individuals, process claims, and engage in a variety of case management/disease management activities to encourage the appropriate use of medical resources. If they collect more premiums than claims paid, their medical loss ratio is less than 100% and they earn a profit.

In a world of accountable care organizations and healthcare reform, new reimbursement methods will include global payments to providers, which implies the risk of loss will shift from the payer to hospitals and clinicians. Payers will no longer need their large claims processing staff, nor create complex actuarial models. They’ll become very different organizations.

How different?

My prediction is that payers will become the health information exchange and analytics organizations that help hospitals and clinicians manage risk in a world of capitation.

I’ve said before that ACO=HIE+Analytics.

The payers are already making strategic acquisitions to build these new business models

Aetna acquired Medicity to gain expertise in healthcare information exchange. Aetna had already acquired Active Health to gain access to its CareEngine analytics platform.

The Effect Of Physicians’ Electronic Access To Tests: A Response To Farzad Mostashari

Mar 13, 2012• 17

By Danny McCormick, David Bor, Stephanie Woolhandler
and David Himmelstein

Our recent Health Affairs article linking increased test ordering to electronic access to results has elicited heated responses, including a blog post by Farzad Mostashari, National Coordinator for Health IT. Some of the assertions in his blog post are mistaken. Some take us to task for claims we never made, or for studying only some of the myriad issues relevant to medical computing. And many reflect wishful thinking regarding health IT; an acceptance of deeply flawed evidence of its benefit, and skepticism about solid data that leads to unwelcome conclusions.

Dr. Mostashari’s critique of our paper, will, we hope, open a fruitful dialogue. We trust that in the interest of fairness he will direct readers to our response on his agency’s site.

Our study analyzed government survey data on a nationally representative sample of 28,741 patient visits to 1187 office-based physicians. We found that electronic access to computerized imaging results (either the report or the actual image) was associated with a 40% -70% increase in imaging tests, including sharp increases in expensive tests like MRIs and CT scans; the findings for blood tests were similar. Although the survey did not collect data on payments for the tests, it’s hard to imagine how a 40% to 70% increase in testing could fail to increase imaging costs.

Dr. Mostashari’s statement that “reducing test orders is not the way that health IT is meant to reduce costs” is surprising, and contradicts statements by his predecessor as National Coordinator that electronic access to a previous CT scan helped him to avoid ordering a duplicate and “saved a whole bunch of money.” A Rand study, widely cited by health IT advocates including President Obama, estimated that health IT would save $6.6 billion annually on outpatient imaging and lab testing. Another frequently quoted estimate of HIT-based savings projected annual cost reductions of $8.3 billion on imaging and $8.1 billion on lab testing.

We focused on electronic access to results because the common understanding of how health IT might decrease test ordering is that it would facilitate retrieval of previous results, avoiding duplicate tests. Indeed, it’s clear from the extensive press coverage that our study was seen as contravening this “conventional wisdom”.

Engaging “The” Patient

Mar 13, 2012• 2

By Adrian Gropper

The digital identity of patients will come to the fore as the nationwide health information network (NwHIN) takes practical steps to support care coordination, patient engagement and quality transparency. These changes in health care delivery are the essential foundation for cost containment and arguably the essence of Meaningful Use.

Stage 2, as proposed, is a giant step toward care coordination and patient engagement. The focus on Direct and meeting the patient and doctor where they are – on the Internet – rather than where they might be (HIEs and PHRs) is both practical and empowering. But, what does “the patient” mean in a digital, networked system where patient identity is not always based on face-to-face encounters and snail-mail?

I doubt that anyone is arguing for biometric patient passports as a prerequisite for medical consultation.

The practical aspects of identifying the patient online can be seen in light of the Stage 2 mandate for Direct messaging across institutions and with the patient. Let’s imagine a paperless, NwHIN, version of today’s Release Of Information (ROI) request that enables one doctor to send records to an unaffiliated doctor under HIPAA and with informed patient consent.

Health Datapalooza 2012: Throw Your Hat Into the Ring!

Mar 12, 2012

By Todd Park

It’s a phenomenal time to be an innovator at the intersection of data and health care improvement. I’m incredibly excited by the rising tide of innovations we’re seeing – new products, services and features being invented by entrepreneurs across the country, fueled by open health data.

And coming soon is the latest opportunity to showcase and learn about many of those innovations: the 2012 Health Data Initiative Forum– aka the Health Datapalooza — being held in DC at the Washington Convention Center on June 5-6, 2012.

For all of you who have been creating value from health and health care data – this is your opportunity to showcase your brilliance for the nation to see! Led by the amazingly talented folks at Health 2.0, the Health Data Consortium is sponsoring a national competition for the best new apps and services created using health and health care-related data. Entry applications for the competition are due March 30^th.

Innovators will then go through an “American Idol”-style process in which panels of consumers, health care professionals, and community leaders will judge innovations submitted. The innovations that best demonstrate benefit and value for health and care improvement will be featured and demoed at the June Datapalooza.

So if you’ve built or are building something terrific with the aid of health data, throw your hat into the ring! Submit your entry form by March 30^th, and may the best innovations win!

Todd Park is the CTO of HHS and has just been appointed CTO of the Federal Government.

(Full disclosure: as is obvious from the article Health 2.0 which is a sister company to THCB is involved as a sub-contractor helping with Health Datapalooza 2012)

Help Shape the Future of Patient-Centered Outcomes Research

Mar 12, 2012• 5

By Bill Silberg

The Patient-Centered Outcomes Research Institute (PCORI) is an independent, non-profit organization created by Congress in 2010. Our mission is to fund research that will provide patients, their caregivers and clinicians with the evidence-based information needed to make better-informed health care decisions.

We’re committed to continuously seeking input from a broad range of stakeholders to guide our work. So as part of that effort, we’re asking for public comment on our first draft National Priorities for Research and initial Research Agenda, which provide a framework for and identify the broad questions that must be addressed so that patients can make better and more personalized decisions in partnership with their clinicians.

We released the draft priorities and agenda on January 23 for a public comment period that runs through 11:59 pm EST on March 15. You can read the draft priorities and agenda, answer 10 questions about them and provide general comments, here

We encourage you to provide comment through our website, but we’ll also accept input by mail. Responses received through pcori.org will be displayed for public view on the site.

After reviewing public comments and other feedback, PCORI will publish a report summarizing the input and explaining how it led to changes in the draft priorities and agenda. PCORI’s Board of Governors then must adopt the priorities and agenda before primary funding announcements can be issued.

PCORI is counting on you and your colleagues to you to help shape our national priorities and research agenda. Your feedback and perspective will help insure that our work is responsive to the needs of patients and those who care for them.

So please visit pcori.org today to provide comment. And to receive regular updates and funding announcements from PCORI, please subscribe to our mailing list.

Bill Silberg is the Director of Communications at PCORI. Reach Bill at bs******@***ri.org.

Patient Rights

Mar 10, 2012• 5

By Rob Lamberts

I was talking to a patient a few days ago who was raving about a local grocery store.

”They get it,” she said. ”They understand how to take care of their customers.”

It made me think about how far medicine has drifted away from the same idea. Ironically, despite the fact that our “customers” (people who pay us for our services) are seeking us so we can “take care of” them, we do a lousy job of taking care of our customers. It has been an obsession of mine since I started practice, but it has been something that has been increasingly difficult to accomplish. I now have to fight against the need to meet “meaningful use” criteria so that I can have time to make the record meaningful and useful to my patients. I have to fight against the need to conform to “medical home,” criteria so that I can make my practice the place my patients see as their ultimate medical haven.

The more the government and insurance industries push me toward focusing on my patients, the less time I have for my patients because of the need to meet criteria proving that I am caring for my patients. It’s a mess.

So I went back to my roots. What do I really think should be the rights of my patients? Here is a list that I made:

Patients have the following rights:

The right to have access to care when it’s needed
This does not mean the care is done in the office either. It can be done over the phone or via computer.
The schedule of the office should accommodate the patients’ needs as much as is reasonable to expect.
The right to have care that is convenient
They should not have to wait to be seen or wait on the phone to be heard