The Health Care Blog – Page 856 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Silly Season: Monty Python Policy Making

Oct 19, 2009• 5

By IAN MORRISON

Editor’s Note: Ian Morrison today makes his first contribution to THCB. Ian was President of Institute for the Future where I learned my health care consulting trade in the 1990s. A more amusing boss one couldn’t have hoped to have and he never minded me (or half of health care) shamelessly stealing his jokes–although his Scottish brogue always gave them a zing none of us can quite match. Ian’s now a full time speaker/writer/futurist and he gave THCB his view of the health care debate, interpreted logically through the lens of Monty Python’s Flying Circus–Matthew Holt

Now we are down to the really fun part of healthcare reform, when they actually write the final bill and figure out ways to pay for it. And to honor the 40th Anniversary of Monty Python’s Flying Circus’s debut, Congress and the Administration have entered the silly season where final policy is turned into law.

I love the American healthcare system, not because it is the best in the world, but it is the funniest. The laughs keep coming. Here are a couple of my latest favorites.

Change The Rules and Get Your Labs

Oct 19, 2009• 4

By PHIL MARSHALL

In 1999 Caresoft developed a consumer web portal called the Daily Apple. The Daily Apple wasn’t all that unique or different than other health portals, until in May of 2000 they began helping consumers download their lab test results from Quest Diagnostics. Now THAT was different! A portal aggregating real clinical data on behalf of consumers, with the potential to drive personalized health information, recommendations, and alerts to the individual. “Looks like your exercise and your diet are keeping your blood sugar under good control. Great Job!” and “Your liver enzymes are elevated, which might be due to your Lipitor. You should talk with your doctor.” Now that’s information a person can use! But sometimes even the best ideas suffer from poor market timing. It was only 19 months later, in December, 2001, that the service was discontinued. Many of us on the outside wondered why such a seemingly unique and valuable service would be disabled. But whether it was the lawyers, the doctors, or the business model, timing wasn’t right.

Only a couple years later, in 2003, the Office of Civil Rights at HHS wrote the HIPAA Privacy Rule regulations, allowing consumers to access a copy of their own protected health information. But they carved out lab data as a special case. Lab data (or data governed under the Clinical Laboratory Improvement Amendments, or CLIA), was to be governed under CMS regulations that stated that lab test results could only be delivered to “Authorized Persons”, defined as “an individual authorized under state law to order tests or receive test results, or both.”Continue reading…

A Crucial Requirement To Cure U.S. Healthcare Long-Term: Curb Raging Inflation

Oct 16, 2009• 9

By Al Waxman, PhD

The Senate Finance Committee pushed the likelihood of mandatory U.S. healthcare insurance a giant step forward this week by passing a healthcare reform bill that is likely to become law in some form by year-end. That’s the good news. Unfortunately, this is dwarfed by the bad news: The focus of the legislation is the implementation of healthcare for the uninsured, not fixing the healthcare system overall. So the need to substantially trim crippling U.S. healthcare inflation rate is getting lost in the shuffle.

Healthcare premiums have soared because healthcare inflation is nearly triple the overall inflation rate. Last year, during a period of general deflation, healthcare inflation rose 5.5 percent. Healthcare costs are expected to consume nearly 20 percent of the GDP by 2017, the year that Medicare is projected to become insolvent.

While there is still time, policy makers must take steps to substantially amend the nature of healthcare reform. They must set clearly articulated goals, including a normalized healthcare inflation rate. They must build alignment across multiple interest groups to make sure that all key stakeholders are truly on board, not just passing legislation. Most important, they must shift the focus of the debate from “who pays” to “how much” America should pay for an effective healthcare system that delivers real value. If this isn’t addressed, no changes will ultimately succeed.

Why AHIP needs the public option

Oct 16, 2009• 38

By Matthew Holt

It’s been a fun week. After years of THCB explaining that neither could AHIP do genuine research nor could its venerable President open her mouth without lying, the rest of the world has caught on. I won’t rehash the blow by blow here—Jonathan Cohn is among many who’s done that already—but essentially AHIP commissioned PWC to include the half of the analysis about the Baucus bill that was favorable to them and leave the rest out. And the fall from grace has been particularly fun to watch. Even the whores from PWC who wrote the report criticizing the bill have been backing away from it. And some astute commentators think that the debacle has helped the likelihood of a more liberal bill’s passage.

Now to be fair (or overly fair as they’d never concede this to the other side), the insurers have a point. They loaded Baucus up with lots of cash and put a former Wellpoint exec in as his chief of staff. They romanced the White House and kept quiet when Pelosi and the rabble criticized them. The deal they thought they’d cut was that they would give up the way they currently make money by underwriting and risk skimming in individual-small group and being overpaid for Medicare Advantage, and in return they’d get 45 million more customers, all forced to buy insurance and subsidized by the government to do so.

But somehow along the way the Democrats, despite lots of tough talk about “bending the curve,” lost the cojones to find even a mere $100 billion a year to redistribute from the probably $1 trillion waste in our $2.5 trillion health care system.

Health Care Reform Lite

Oct 16, 2009• 24

J.D. Kleinke

J.D. KLEINKE

“The only constant in health care is change.” It’s one of those shop-worn things you hear too often on health care’s rubber-chicken circuit; and not only is it not true, but it is exactly untrue.

Of course, there is one thing different in 2009: everybody gets to whine about it on Facebook.

So too health care reform. When the “journalists” at Fox News, the red-faced demagogues in Congress, and the alarmists in your organization are done ranting about “ObamaCare” and the sky falling, understand that the essence of the health care bill moving forward today is one very simple thing: a violent endorsement of the status quo, paid for with an artfully diffused redistribution estimated to cost, on an annualized basis, less than 4 percent of the system’s annual $2.2 trillion haul.

Under the plan that looks most likely to pass after some classic Capitol Hill 3 a.m. horse-trading – this time between the grumpy far left and poll-sitting centrists on both sides of the aisle – health care “reform” will involve little of substance beyond (1) the long overdue jamming of 46 million people currently outside the system into that system, and (2) an equally long overdue prohibition against health insurers kicking them back out. For the middle-class taxpaying swing voter in denial of what could happen in 90 horrifically unlucky days at their job and within their bone marrow, i.e., the average voter with coverage they might not be able to afford after simultaneously being fired and getting leukemia, #2 is worth the entire effort – and the reason any politician of calculation if not conscience should vote for the plan.Continue reading…

Health 2.0 and the Big Bang

Oct 15, 2009• 8

By GLENN LAFFEL

It’s hard to believe that last week’s Health 2.0 conference was just the third annual installment of the event. The phrase, “Health 2.0” entered our lexicon at light speed and seems to have been there longer than those few, short years. The conference has become a must-attend for hundreds of people, dozens of companies and a hodge-podge of innovators, consumer activists, and buzz trackers.The Twitter feed from last spring’s Boston event rivaled that produced by the Octomom (well, not quite), and had the wireless carriers supporting last week’s event not sustained a massive H1N1 attack, that feat would have been surpassed easily. Heck, even Aneesh Chopra, our nation’s first-ever CTO, was there to kick it off. Congratulations are in order for the conference organizers, Indu Subaiya and Matthew Holt, but going forward they will have their hands full attempting to manage the wild growth of their event.

Why Standards Matter 2: Health IT Enters a New Era of Regulatory Control

Oct 14, 2009• 12

By DAVID C. KIBBE and BRIAN KLEPPER

David Kibbe The recent history of electronic medical records in ambulatory care, or what we now call EHR (electronic health record) technology, can be divided roughly into three phases. Phase I, which lasted approximately 20 years, from about 1980 to the early 2000’s, was an era of exploration and early adaptation of computers to outpatient medicine. It coincided with the availability of PCs that were cheap enough to be owned by many doctors, and with the increased capacity of off-the-shelf software programs, mainly spreadsheet and database management systems such as Lotus, Excel, Access, and Microsoft’s SQL, to lend themselves to computerized capture of health data and information. Phase II coincided roughly with the American Academy of Family Physician’s (AAFP’s) commitment to health IT as a core competency of the organization, and with its support/promotion of the early commercial vendors in the Partners for Patients program, a national educational campaign inaugurated in 2002 which involved joint venturing with vendors that included Practice Partners, MedicaLogic, eClinicalWorks, and eMDs, among others. Several other physician membership organizations joined this effort to popularize EMRs, or crafted their own education programs for their members based on the AAFP’s model. The most popular Phase II products were, and still are for the most part, client-server software applications that run on local networks and PCs within the four walls of a practice, and tend to use very similar programming development tools, back-end databases, and support for peripherals such as printers. The industry grew, albeit sluggishly, from roughly 2002-present in an unregulated environment, with increasing support from quasi-official industry groups like HIMSS and CCHIT, and with the blessing of many professional organizations, including the AAFP, ACP, AOA, and the AAP. Best estimates are that the numbers of physicians using EHR technology from a commercial vendor roughly tripled during this period, from about 5% of physicians to about 15%. The Bush administration gave moral support to the industry, but did not provide funding or payment incentives, and mostly left the industry to itself to sort out the rules, including certification. The industry is now entering a new phase, one we predict will significantly depart from the previous two eras.Continue reading…

What’s Next? Follow the Money

Oct 14, 2009• 17

By ROBERT LASZEWSKI

With the passage of the Senate Finance bill the health care effort now moves to a critical stage with the Senate Majority Leader and the House Speaker now clearly in charge. The more important effort will be Reid’s. Pelosi’s final product will be more predictable (very liberal) but Reid’s will have to be more practical. Every inch Reid moves away from the more moderate Baucus bill will cause problems.

The big issue is going to be money—just whose taxes are going to get raised to the tune of $500 billion to pay for it.

The Senate Finance bill has the $211 billion “Cadillac” benefits tax. Dead on arrival. No way the party that put the unions ahead of the Chrysler bondholders is going to cross their traditional allies on this one. The $40 billion tax on medical device makers is also under pressure and likely to at least shrink.Continue reading…

Why is this the one thing?

Oct 14, 2009• 11

By JOE FLOWER

When the terrorist attacks of 9/11 hit the United States, and then suddenly we were plunged into war, first in Afghanistan and then in Iraq, I don’t remember anyone demanding that the wars be “deficit neutral.” No one talked about whether we could afford them. They were things we just had to do.

When George W. Bush proposed giving vast sums to rich people in the form of tax cuts, no one argued that it would be “deficit neutral.” Rather, it was argued that cutting taxes wouldn’t bring in less tax revenue at all, it would bring us more tax revenue, because the economy would grow so much faster. And besides, it was somehow terribly urgent, something we just had to do.

When the banks tottered and needed to be shored up with taxpayer money to the tune of nearly $1 trillion, there was no way to argue this would be “deficit neutral.” We might get the money back, we might not. Whether we could afford it was not the question, we just had to do it to save the banking system. Similarly, the “Stimulus Bill” was terribly urgent, and something we just had to do, whether we could afford it or not.Continue reading…

Will We Get a Health Care Bill in 2009?

Oct 14, 2009• 34

By ROBERT LASZEWSKI

It’s decision time. The Congress will or won’t pass a major health care bill during the next few weeks.Will we get health care reform in 2009?Almost certainly not. As I have been saying for months, if we get a bill it will be more a trillion dollar entitlement expansion funded by relatively minor provider cuts and about $500 billion in tax increases.

That is not health care reform.Will we get that trillion-dollar entitlement expansion health care bill?That outcome lies in the coming convergence on Capitol Hill of three extraordinarily powerful, and contradictory, forces.