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Pioneer Speaks about MA Health Reform

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By PAUL LEVY

Picture 66 The Pioneer Institute is a public policy research center in Massachusetts. On the political spectrum, most people would call it conservative, or a least free-market oriented. In my opinion, regardless of your particular position along that spectrum, the institute’s work is worth reading.

Last month, it issued a paper about the Massachusetts health care reform experiment that serves as a report card on a number of factors, with particular focus on the question of the equity and sustainability of the financing of the health care insurance access system put in place by Chapter 58 of the Acts of 2006.

For those interested in the possible applicability of the Massachusetts model to the national scene, authors Amy M. Lischko and Kristin Manzolillo say:

It is undeniably premature to enact a reasoned national-level solution based on Massachusetts’ or other state experiments. . . .Continue reading…

A little HIMSS housekeeping

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By MATTHEW HOLT

Today till Weds I’ll be at HIMSS in Atlanta. You can see me at the Bloggers panel at 3pm Monday, or more importantly at the talk Jane Sarasohn-Kahn & I are giving on Health 2.0 & Participatory Medicine at 1pm on Tuesday in Georgia Ballroom 1.

I’ll also be wondering around with the trusty flipcam, so expect to see a few schedules and not so scheduled interviews up on THCB too. And you can always follow my twitter feed http://twitter.com/boltyboy If you want to meet me, best bet is to DM or follow my social schedule here although with Jetlag waking me up at 4am not sure how long I’ll last tonight!

Interspersed in all of that tech stuff, THCB will roll on as usual. I’ll let you know in 3 days time if the tech sector in health care has made more progress since last year than their political cousins!

23 skiddoo

I think the Chelsea fans with whom I went to the game today think I’m a bad omen. First loss in 39 games at home dating back to 2008

It’s Up To Us …

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By PAUL LEVY

Levy A conversation with a reporter yesterday helped me clarify my thoughts about federal health care legislation. In my view, the most effective role of the federal government would be to provide national standards by which the health insurance companies operate (e.g., with regard to pre-existing conditions, rescission, and lifetime limits), require the existence of insurance exchanges, and establish the conditions under which universal access to insurance is made possible. Other items I would suggest for federal legislation are summarized below.

I am hoping the US government will not attempt to control the costs of health care by making legislative decisions with regard to clinical matters. Not because we should abandon cost control; but because federal efforts in this sphere are likely to be crude and not clinically appropriate. You just have to look at the process by which the USDA food pyramid is influenced by food product lobbyists to imagine how the government would attempt to regulate the design and provision of care among medical specialties, equipment and supply manufacturers, and pharmaceutical companies.

As should be evident to readers, I think it is possible for the participants in the health care system to accomplish major changes in the rate of medical cost inflation. Two articles have this theme. One is by Business Week’s Catherine Arnst. The other is by Lucien Leape, Don Berwick, and others in Quality and Safety in Health Care. Both are worth reading, and they overlap in recommending several areas — reducing infections and other preventable harm; empowering patients and families to participate in their care; and disclosing and apologizing for mistakes.

Beyond these articles, there is a remarkable consensus on these items, and yet hospitals and doctors often fail to implement them. Even hospitals that house some of the most accomplished authors in these fields often do not follow the advice of those colleagues when it comes to making improvements in the delivery of patient care.

It is not unusual for industries facing structural change to be slow to move. Why? Because the leaders of those industries were promoted based on their success in the past financial, political, and social environment. They were hired for their ability to maintain the status quo, rather than for their ability to make change. Eventually, though, societal forces make themselves felt. If an industry does not adapt, the government will step in. The medical profession has to decide whether it wants to take charge of this process or abdicate to Congress the right to act in its stead.

The White House Healthcare Summit – Democrats 0 Republicans 0

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Laszewski

There is politics and there is policy.

On the policy front what we saw today was the same exchange of the old talking points we have watched for a longtime. No progress was made toward any kind of health care bill. That is no surprise–this was never going to be the place to
fashion any kind of compromise.

At the end the President asked the Republicans if it was worth it to spend another month or six weeks trying to come to some agreement. I am glad he did that. I am not optimistic but a “yes” from the Republicans would be the right answer for the country.

On the political front this was a win for Republicans because it was a draw. Granted, they have a very thin health care agenda but all they had to do was hold their own over the course of the day. Politically, if not on policy, they did that. No minds were changed in the room and likely none out in the country. The left will still say get on with passing this, those on right will say kill it, and the majority of critical swing voters will still be concerned that the Democratic bills are going too far too fast in the face of the Great Recession. This is the biggest reason I don’t hold out a lot of hope there will be a lot of Republican willingness to come to the table–at least before the November elections.

Ironically, this “bipartisan summit” may have just increased the political cynicism in the country because it went off so predictably.Continue reading…

Pay (Only) for Health Care that Works

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By DAVID HYMAN

Health care is expensive partly because governmental payers and insurers foot the bill for large quantities of medical services that are ineffective, unnecessary, or unproven. According to a RAND report, studies of clinical efficiency “indicate that one-third or more of all procedures performed in the United States are of questionable benefit.”

When state and federal governments set the minimum terms for insurance coverage, this problem is likely to worsen. Governmental decisions reflect the political power of providers (who want to sell more services), the sympathy felt for patients (who want to consume more services and have other people pay for them), and the desires of bureaucrats (who generally want to maximize their budgets and their importance). These interests coalesce, causing governments to aggressively mandate coverage of services that may or may not be necessary.Continue reading…

Not exactly what athenahealth was looking for

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By MATTHEW HOLT

This is not a fun day for athenahealth, and frankly with HIMSS coming up, not a fun time to have such a day. None of this has anything to do with their products or their client services, but late last night the company announced that it’s going to be restating its earnings. You can see a longer discussion on The Street.com but essentially it appears that athenahealth has been amortizing its installation costs over one year whereas they ought to have been doing it over more years. The net result is that they’ll have to restate some earnings and are going to miss the next earnings reporting deadline. The stock is off roughly 12% today.

Athn

What’s been happening is that the new CFO (Timothy Adams) has come in and cleaned house, and not liked what some of the old CFO (Carl Byers who moved to Chile!) had been doing. Long term this clean up is probably good news. The company is still operationally profitable (we assume!), and its business of running the back office and increasingly front offices of doctors using a combination of technology and forklifts/sweat remains a great way of both routinizing their businesses and aggregating data for overall process improvement.

So better to get any financial “irregularities” cleared out now and be more conservative. But while other than the shareholders (and the coming lawsuits) it probably doesn’t matter much, this may per chance slow down Jonathan Bush a touch next week. Or maybe not. We’ll see….

The Messy Business of Transparency

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By NAOMI FREUNDLICH

Picture 120President Obama’s latest plan for health reform brought a flurry of commentary in the last two days; including divergent views on whether his commitment to “transparency” is helping or hurting the process. Yesterday, the Los Angeles Times blamed the current “healthcare backlash” on Obama’s insistence that the messy business of hashing out health reform be done in Congress, not behind closed doors in the Oval Office. In the L.A. Times’ view, there’s been too much transparency:

“By leaving the overhaul in the hands of Congress, [Obama] has given the public a full view of how lawmakers do business. The result is an anti-Washington mood that Republicans have tapped into.”

Meanwhile, the House GOP leader John Boehner, calls the Obama plan—introduced yesterday on the eve of the “bipartisan” health summit—a “Democrats-only backroom deal” that “doubles down on the same failed approach that will drive up premiums, destroy jobs, raise taxes, and slash Medicare benefits.” In the Republican’s view of things, there’s been too little transparency in the health reform process.

So which is it: Back-room dealing or a too-public view of the dirty business of lawmaking?

At the very beginning of the health reform process, the Obama administration made a conscious decision not to repeat the mistakes that doomed Bill and Hillary Clinton’s plan for universal coverage in 1993. The consensus was that the Clinton plan ultimately failed because the bulk of the planning went on behind closed doors—Congress and the American people felt locked out and were blindsided by the cost of the proposal. “With a task force that operated largely in secret, the first lady drew up a detailed and complicated plan that met with fierce opposition by the health care industry and Republicans before it ultimately sank of its own weight in a Democratic Congress,” writes Peter Baker in the New York Times.

Continue reading…

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