Above the Fold
Washington DC conference and party!
Wednesday morning I’ll be at the AHRQ annual conference in Rockville, Maryland. I’m moderating a panel looking at “Experiences in Patient-Centered Care: Improving Coordination and Communication among Patients and Providers”. Given this is an AHRQ meeting there’ll be actual research presented from:
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- Gail Brottman, Director of Pediatric Pulmonary Medicine at Hennepin County Medical Center in Minneapolis;
- Jennifer Uhrig, Senior Health Communication Scientist at RTI;
- Jim Tufano, Assistant Professor, University of Washington’s program in Biomedical & Health Informatics
Of course I’ll be dragging them down to my non-academic level pretty soon!
If you can’t join the academics in the morning, you may want to come by a drinks party hosted by my friend Maggi Cary in the evening. For that one you’ll have to email me to find out a few more details!
Obama’s Medicare Half-Truth
Obama was called a liar during his recent address to a joint session of Congress. Actually, he was not fully truthful
about the implications of cuts to Medicare. Obama repeated that his
health reform plan includes payment cuts for private Medicare Advantage
(MA) health plans:
The only thing this plan would eliminate is the
hundreds of billions of dollars in waste and fraud, as well as
unwarranted subsidies in Medicare that go to insurance companies —
subsidies that do everything to pad their profits and nothing to
improve your care. … So don’t pay attention to those scary stories
about how your benefits will be cut… That will never happen on my
watch. I will protect Medicare.
Obama’s claim that the cuts will trim insurer profits but not Medicare benefits was meant to calm nervous seniors. As I and others
have pointed out the proposed cuts will in fact reduce benefits to some
degree, contrary to the President’s assertion. But seniors, in
general, should not be concerned. First, only about 23% of Medicare beneficiaries are enrolled in an MA plan.
Taxing Health Insurance Companies to Pay for Health Care
The Congress has investigated about every conceivable way to tax people to pay for the health care proposals—a millionaire’s tax, bigger taxes on home mortgages and charitable contributions, and a couple of dozen more ideas.
Now Congress looks to be the most interested in taxing insurance companies to pay for a big chunk of their health care proposals. The new taxes would come in two parts––a 35% excise tax on any health benefit cost above an $8,000 single and $21,000 family annual premium as well as a flat $6 billion annual tax on the industry to be allocated among the companies proportionate to their premium.
There is certain logic to this. Taxing high priced benefits could help deflate the health care economy. Taxing all of the health insurance companies that stand to get more than a $1 trillion in new business—most of it in the from new private insurance and Medicaid subsidies and the rest from the consumer’s share of those new private plan premiums—seems fair at one level.
Calling for a tax on that big rich insurance company also sounds a lot better to the politicians than looking voters straight in the eye and raising their taxes directly.Continue reading…
Health 2.0 Conference
Health 2.0 is right around the corner – be sure to register before it sells out! If
you are a practicing physician and want a special opportunity to
review Health 2.0 tools and attend the conference for free, apply here.
CCHIT’s Latest Gambit
Many of us have enjoyed a few good minutes of fun having our fortunes told by soothsayers who claim they can predict our future based on patterns of tea leaves in a cup or the playing cards we’ve pulled from a deck.
We pay a few dollars for the entertainment and if the fortune teller is skilled, we are temporarily impressed by his “insight.” But once we leave the carnival, we come back to our senses. Fortune-tellers can’t predict the future.
With its latest announcement, the Certification Commission for Healthcare Information Technology (CCHIT) appears to have entered the fortune telling business.
And if information provided on blogs published by its founders is to be believed, some EHR vendors plan to have their fortunes told by the former EHR certification monopolist.
Background
In June, ONC’s HIT Policy Committee released a Meaningful Use Matrix and proposed that it should serve as the basis for EHR certification as mandated by ARRA, the economic stimulus program signed into law last winter.
The Matrix consisted of five “Health Outcomes Policy Priorities” and associated Care Goals, Objectives and Measures. The Committee anticipated that the latter would be transformed into EHR certification criteria.
After a 2-month public comment period, the Committee tweaked the Matrix, essentially pushing back time-frames for implementing computerized order entry, and accelerating time-frames for implementing personal health records.
By mid-August, the Committee had approved a final version of the Matrix.
This document includes the very latest information on ARRA-mandated EHR certification criteria. It is in the public domain, there for all to see. ONC is expected to finalize these criteria next spring.
The criteria are not consistent with those used by CCHIT to certify EHRs. They are outcomes-oriented (CCHIT’s are feature, structure and process-oriented), and they do not require that any particular technology (such as the client-server applications used by the legacy vendors who sit on the board of CCHIT) be used to achieve the results.
Subsequently, HHS announced that it planned to assume responsibility for deciding which EHR systems qualified for bonus payouts under Medicare, and shortly thereafter, ONC’s HIT Policy Committee said that it planned to recommend that several entities should certify EHR systems.
In its announcement, the Committee envisioned the establishment of 10 to 12 such agencies.
The upshot of these moves by the Federal government are that (1)CCHIT no longer decides what criteria will be used to certify EHRs, and (2)its days as the exclusive provider of EHR certification services are numbered.
What has CCHIT decided to do in response to these setbacks?
It’s decided to become a fortune-teller!
New Role for CCHIT
Last week, CCHIT announced it will begin offering “streamlined,” or “modular” certification options, in which EHR vendors can apply to the agency for approval of distinct EHR modules like e-prescribing or electronic patient registries.
But as mentioned above, ONC won’t sign-off on its “meaningful use” criteria until the spring of 2010. In effect, CCHIT is asking EHR vendors to gamble that CCHIT can, like a fortune teller at a carnival, predict what those final recommendations will be.
“Choose the risk you want to take,” CCHIT Chairman Mark Leavitt recently challenged vendors. “Go ahead now (with a CCHIT review) and have an extra year to implement, with a small risk that there will be some gap in which EHR systems would have to be updated to receive final certification…” or risk the consequences of sitting on your hands, he presumably would add.
Never mind that the latest information is in the public domain, and that any vendor can compare it against their current capabilities and development plans! Disregard the fact that CCHIT has no track-record in promulgating outcomes-oriented certification criteria or in certifying against them!
What is CCHIT charging for its fortune-telling expertise? According to Government HealthIT, a HIMSS sponsored publication, prices for modular certification begin at $6,000 for up to 2 modules. They rise to $24,000 for up to 20 modules and to $33,000 for more than 20.
As always, fees for CCHIT’s comprehensive certification are $37,000 for ambulatory systems and $49,000 for hospital systems. Annual renewal costs are $9,000 for each.
That’s chump-change for the legacy vendors whose top executives sit on the board of CCHIT, but it guarantees nothing.
Conclusions and Recommendations
EHR vendors should perform their own analyses against the published HIT Policy Committee criteria and follow the HHS Web site for announcements regarding meaningful use criteria and the process by which EHRs will be certified.
If a vendor insists on having its fortunes told, it should consult with a reader of tea leaves next time the carnival is in town.
Glenn Laffel is a physician with a PhD in Health Policy from MIT and serves as Practice Fusion’s Senior VP, Clinical Affairs. He is a frequent writer for EHR Bloggers, where this post first appeared.
CBO: HELP Bill’s Public Plan Not Much Help on Costs
The green-eyeshade meanies in the Congressional Budget Office took another whack at the public plan today, at least the one contained in the health reform bill passed by the Senate Health Education Labor and Pensions committee last June. Responding to queries from ranking member Michael Enzi (R-WY), CBO chief Doug Elmendorf noted on his blog that “premiums for the public plan would typically be comparable to the average premiums of private plans offered in the insurance exchanges.”
The reason given was the HELP bill emasculated the public plan’s ability to piggyback on the administrative efficiencies of Medicare and required it to be “financially self-sufficient.”Continue reading…
Protest songs in health care?
A health care reform protest video that rocks! (Hat-tip to ePatientDave)
What Voters Really Think About Evidence-Based Health Care
By ROBERT LASZEWSKI
I want to call your attention to an important survey done by the California-based Campaign for Effective Patient Care. They surveyed California voters on their understanding of evidence-based medicine.The bad news is that patients think their health care treatment is generally evidence-based even though that assumption is highly questionable. The good news is that patients want it to be evidence-based.At a time when we hear anecdotal evidence, particularly from town hall meetings, that people don't want any "interference" between them and their doctors they do seem to appreciate they need to get all of the facts when making a treatment decision.Here is the survey summary. You can access all of it here.
Groupon, Livingsocial, and digital norms
Regular readers may have noticed that I am a bit of a social media junkie– this blog, Facebook, Twitter — but I am also intrigued by social media sites that are set up only for commercial purposes. It is fun and instructive to watch the evolution of these sites.
Along those lines, a few weeks ago, I wrote about Groupon. The concept: The retailer offers a discount deal in the city of your choice, but only if enough people sign up for it.
The viral power is amazing, because after you sign up for something you want, you contact all your friends asking them to do the same so you can get the deal. Meanwhile, the retailer gets noticed by people with an affinity for his/her product or service, and gets a bundle of cash in prepayments. The folks at Groupon get some kind of fee. Everyone is happy
Now arises a new site, soon to go into business, called Livingsocial. Like Groupon, you can sign up for the deal of the day, and if enough people sign up, the deal is on; but unlike Groupon, if you get three other people to sign up for the deal, you get your coupon for free.
