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Above the Fold

Marooned in the Horse Latitudes

Jul 6, 2010• 15

By JEFF GOLDSMITH

More than a year after glimpsing “green shoots” of economic recovery, President Obama saw nothing but parched brown in June’s employment numbers. The continuing stream of bad economic news is a far greater threat to his Presidency than that sickening orange plume of oil furiously gushing into the Gulf of Mexico. The 9.5% June unemployment rate is essentially the same as it was a long thirteen months ago.. And support in Congress for more pump priming is essentially at an end. Despite a 59 vote Senate majority, an increasing number of Democrats as well as the Republicans appear unwilling further to increase the federal deficit, even to extend unemployment benefits.

In 2010 thusfar , the economy has replaced only 600 thousand of the 8 million jobs lost in the recession. Only a little more than 100 thousand new private sector jobs have been created in the past two months, while the labor force shrank by almost a million. If you add discouraged workers and those working part time involuntarily to the people officially unemployed, there are almost 26 million people out of work. A lot of those young people who fought to make Barack Obama President will have spent at least half of his term living in their parents’ basements.

President Obama is trapped between his increasingly angry core Democratic constituents- public sector unions, minorities, young people- and their muse, former economist/now political polemicist Paul “Jeremiah” Krugman, who believes we’re in a depression and need to throw yet more borrowed money from helicopters, and the rest of the country that is trying mightily to pay down their debts and is profoundly uncomfortable mortgaging our future to the Chinese. It’s not obvious that either formula for salvation- the traditional Democratic balm of more money for worthy causes or the traditional (pre-George Bush) Republican regime of austerity and balanced budgets- gets the economy out of the ditch. Captain Obama has not enough political support to pursue either course, so the Ship of State and his Presidency are becalmed, sails flapping, sweltering in the Horse Latitudes.

HIT Trends Summary for June 2010

Jul 6, 2010

By MICHAEL LAKE

This is a summary of the HIT Trends Report for June 2010. You can get the current issue here.

E-prescribing. Not much to report here other than some feedback to the DEA around its long-awaited proposed rule to allow e-prescribing of controlled substances. Other than the Surescripts rightful defense of its history as an industry certifier, these are largely requests for clarification and cautions from the pharmacy industry that smaller pharmacies may have some difficulties.

EHR. The big news this month is the Allscripts and Eclipsys combination. An integrated hospital and physician practice product will be increasingly important as hospitals reach out to affiliated practices with EMR solutions and plans to build clinically-integrated accountable care organizations. Also of note was the announcement by Dell and Practice Fusion to package up its software-as-a-service (SaaS) EMR for smaller practices. EMR suppliers are firming up their supply chains to make purchases as simple as possible. Dell has similar relationships with other companies including eClinicalWorks, Allscripts and others.

GE Healthcare also followed up on its recent acquisition of MedPlexus, a SaaS EMR, with the launch of its Centricity Advance product for smaller practices. According to Health Data Management it’s being priced at $4K-$9K start up and $300-$800 per month. The launch event included a demo by a solo doc using the software and commentary by Newt Gingrich, Peter Basch, MD and others.

HITECH. HITECH this month focused on safety-net providers with grants to boost IT use and funds to figure out how they participate in reimbursement incentives. One project is part of a $2B HRSA grant under ARRA to expand health services to low-income and uninsured. Each recipient was awarded between $500,000 and $3M for new and enhanced EHR implementations and other uses. The other is a small grant to encourage participation of safety net providers in government programs. It’s a reminder that health IT in poorer communities is particularly challenging. Also out this month is a comprehensive policy view of HITECH by Manatt from an impressive cross-section of industry leadership. Study was supported by CHCF, Colorado Health Foundation and UHF.

Healthcare.gov, and health care at OSCON

Jul 6, 2010• 1

By Matthew Holt

I'm trying to get better about putting my KOMO radio spots up here, if only because trying to be coherent about a topic in a couple or 45 second soundbites is pretty hard and therefore good practice. Today I'm talking about the new website launched last week by HHS called Healthcare.gov

Here's my two minute explanation (aimed at a the typical AM radio listener in Seattle).

Matthew talks about Healthcare.gov

One of the best analysis I've seen about Healthcare.gov is over on the O'Reilly Radar written by Andy Oram. You should check it out directly. Andy's coverage of healthcare.gov is part of a bigger interest in healthcare generally from the O'Reilly & Web 2.0 communities, which we of course welcome! (They are partners in the Health 2.0 Developer Challenge)

One place where there's room for lots more activity is in Open Source in health care. Andy has been working hard on getting healthcare into the upcoming OSCON Conference in Portland, OR July 19-23. Here's the Health Care OSCON track. And here's Andy's preview of what will be in the track.

Andy wrote to me with some additional information about the Birds of a Feather meetup:

I want to encourage any interested person nearly Portland, OR to come in for Birds-of-a-Feather sessions even if they can't afford to attend the conference. BOFs are officially for session attendees,but no one ever checks badges and I organized the BOFs in the hope of drawing in more local people:

The BOF session on Healthcare is Thursday July 21 at 7pm

Finally, three podcast interviews with health care speakers who'll be at OSCON:

Brian Behlendorf, one of the founders of the Apache web server project and the CollabNet cooperative software development company, now with HHS on the CONNECT software project
Arien Malec, coordinator of NHIN Direct at ONC (and former RelayHealth-er)
Fred Trotter, open source advocate in health care and organizer of the (separate) OSHealthcon summit.

So if you're interested in open source and health care, you should make your way to Portland for OSCON.

Bizarre PR pitch of the year so far

Jul 6, 2010• 5

By Matthew Holt

I get emails from PR companies all the time pimping this or that client, but they don’t get a lot stranger than this one. (I‘ve hidden the names to protect the guilty):

Subject: Top 3 Reasons Why Health Insurers Are On Your Side…

Hi Matthew,

Health plans are typically portrayed as the evil empire, bent on raising premiums and squeezing every shred of patience out of their members. But, what if I told you that in reality, that isn’t the case?

Here are the top 3 reasons why your health plan really is in your corner and why it is in their best interest to keep you healthy:

1. The healthier you are, the more profitable it is for your insurance provider. Therefore they should go out of their way to keep you healthy with preventative care recommendations.

2. Your health insurer is in a position to get you access to the providers and specialists you want, when you want them. A plan biggest differentiator and selling point is its provider network. It benefits both the plan and the member to have the most skilled, sought after providers a part of the network.

3. Health plans have a 360 degree view of every member’s care. Unlike individual healthcare professionals, plans know every touch point their members have with providers and can make care recommendations.

How about a story that looks at why plans get a bad rap, and actions they are taking that are in their members’ best interests that aren’t typically publicized?

I can put you in touch with REDACTED of HEALTH IT VENDOR who can elaborate on the top 3 reasons and discuss steps that plans are taking to improve the flow of information between plans and providers and plans and members leading to more efficient and effective care.

What do you think?

Regards,
REDACTED

I thought that the careful THCB reader might come up with some interesting analysis about whether health plans are actually doing what this PR maven thinks they’re doing. And I’m sure one or two other THCB readers may not be convinced that insurers are “on your side”

How Would Modern Medicine have Helped our Early Patriots?

Jul 5, 2010• 12

By ED PULLEN, MD

On Independence Day I thought it would be interesting to look at the causes of death of some of our famous Revolutionary era patriots. When I started researching this I anticipated early deaths from infections and untreatable chronic diseases like diabetes and hypertension. Interestingly many of the famous early Americans lived to a ripe old age, and died of causes that even today may well have been their demise.

George Washington: Washington is an exception to the comment above. Washington died at age 67, likely of a pharyngeal infection, possibly streptococcal disease. Today he would likely have received antibiotic treatment and survived this illness.

Do-It-Yourself Health Care

Jul 5, 2010• 5

By PATRICIA SALBER

I was debating merits of DIY healthcare with my buddy, Brian Klepper, PhD -healthcare analyst and pundit extraordinaire – the other day. He is not a fan, preferring instead to have better, stronger, more informed, technologically enabled physicians working in accountable care organizations. I am also a big believer in ACOs, patient-centered medical homes, and informed physicians, and all that stuff, but I think increasingly health care consumers (aka patients) are going to want to control more of their healthcare than they are currently able to do today.

The internet has made medical information more accessible than ever before. People with serious illnesses and/or chronic diseases sometimes end up knowing more about their condition than their physicians. But reading and understanding a medical condition is only scratching the tip of the consumer empowerment iceberg. What I am really interested in exploring is how technology can be used to further drive a true “consumer-directed healthcare” revolution.

Now I want to make it clear I am not proposing that people do their own surgery (although some have done it). Nor am I proposing self-prescription of expensive and/or potentially toxic therapeutics. But I am talking about consumers being able to order their own lab tests without involving a physician…and self-prescription of certain categories of medications (e.g.,statins).

A Permanent “Doc-Fix” Remains Elusive

Jul 5, 2010• 7

By NAOMI FREUNDLICH

For now, all those physicians who threatened to make a mass exodus from Medicare can take a breather. Last week, the House voted to once again delay the mandated 21% cut in physician fees by another six months; thereby ensuring that the fight over the sustainable growth rate (SGR) will be resurrected sometime around Thanksgiving.

So far, Congress has kicked the SGR can down the road 10 times since 2003—four times just this year alone. The targets have long been considered unobtainable and the mandated physician payment cuts are opposed in Congress by Democrats as well as Republicans and supported by nearly no one. The level of anxiety among doctors continues to escalate every time the issue is raised—even though the cuts have never gone into effect for more than a couple of weeks. Why not get rid of this devilishly frustrating formula once and for all?

The short answer is that getting rid of the SGR—even though it has never led to any savings in Medicare—is just too expensive on paper. The Congressional Budget Office establishes a “baseline” projection of future spending and revenue that takes into account that all current laws will be enforced. Legislation that eliminates the SGR targets would then be scored by the CBO as adding to the deficit—to the tune of $276 billion between 2011 and 2020 even if Medicare payment rates to doctors were frozen at 2009 levels. In the current economic climate, it will be very hard to get enough members of Congress to agree to a permanent “doc fix” that eliminates the SGR targets without also finding a way to pay for it.

The Not For-Profit / For-Profit Divide

Jul 2, 2010• 11

By PAUL LEVY

Many people involved in hospitals wonder how it can be financially prudent for investors to put their money into for-profit ventures that buy non-profit hospitals. (Examples here and here.) After all, the argument goes, the newly privatized entities will have to pay taxes, issue taxable rather than tax-exempt debt, lose the benefit of philanthropy, and otherwise be at a competitive disadvantage compared to their antecedents.

In answer, some might make the case that for-profit firms will run hospitals more efficiently. But this is an unproven and unreliable basis for such transactions. Even if there were some efficiency gains, they would be unlikely to offset the additional costs listed above.

No, the answer lies in the risk-reward expectations of equity investors and of purchasers of high-yield taxable debt.* Those expectations are quite different from purchasers of the municipal or other tax-exempt bonds that support the capital needs of non-profit hospitals. It is the difference between a forward-looking, optimistic view of the world and a backward-looking, cautious view of the world.

Let’s start with the tax-exempt debt market, one characterized by risk-averse investors focused on debt coverage ratios and other protections built into indenture agreements.

The rating agencies who serve these investors look at the past performance of the non-profit hospitals and ask, “What could go wrong in the future that might put debt service at risk?” There is a highly limited pool of people interested in such debt, and when ratings fall to near or below investor grade, the number of investors becomes smaller still.

Contrast this with people willing to risk their money in the for-profit world. They are sold on the potential for financial gain, not on the proposition of protecting principal. Those offering this paper present business plans and pro forma’s based on what might be. Sure, due diligence allows an assessment of the downside, but this pool of investors has hedged their bets by building a diversified portfolio.Continue reading…

Consenting Technologies

Jul 2, 2010• 25

By MARGALIT GUR-ARIE

Yesterday, ONC held a fine gathering at the Grand Hyatt in Washington DC. There were experts, ONC Tiger team members and cutting edge technology vendors displaying and discussing platforms and software for providing patients the opportunity to define granular consent to the sharing of their electronic medical records down to a data element level.

Somewhere in the midst of watching that fabulous and very complex technology, it occurred to me that I don’t quite understand why we are discussing all these things. Obviously, we all agree that patients have a right to privacy, and as HIPAA outlines, our medical records ought to be protected from wanton disclosure without our permission. However, the showcased products and the ensuing conversations at the Grand Hyatt were on a completely different level of sophistication.

Physicians have been exchanging patient records since medical records were invented. Today, patients are signing the obligatory HIPAA forms giving health care providers permission for these exchanges, and most doctors use fax, phone, courier (usually the patient) and occasionally secure email to exchange medical records. A typical scenario would be a PCP making a referral – a letter summarizing the problem is usually written, some test results could be attached, a big yellow envelope with some film may be handed to the patient to bring to their specialist appointment. Physicians equipped with EHRs are doing pretty much the same, in a more automated fashion. We do not consider this an invasion of privacy.