The Health Care Blog – Page 864 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

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A “Third School” of Cost Containment?

Nov 2, 2009• 6

By Bill Kramer

Is there a “Third School” of reformers that could help Bill Kramer us resolve the long debate about how to contain health care spending? Drew Altman’s recent column describes the history of the debate between the “Regulators” and the “Marketeers”, and he suggests that a new school of thought – the “System Reformers” – is in the ascendance. According to Altman:

The Systems Reformers believe that the best way to bend the cost curve is not through external market incentives or regulatory controls, but from the inside out, by creating a smarter health care system with the information base, new delivery models and payment incentives that will improve quality and lower costs. . . .

The Systems Reformers’ paradigm is reflected in the “bending the curve” elements of the health reform legislation currently in Congress, which mostly come in the form of pilot projects and experiments. These include tests of ideas like Accountable Care Organizations, “pay for performance” and “bundled payments,” as well as efforts to create a smarter, evidence-based health delivery system through comparative effectiveness research.

He describes the Systems Reformers’ approach as a “third leg of the stool of cost containment strategies.”

While Altman is right about the importance of the Systems Reformers’ ideas, I don’t consider this to be a new paradigm.

Conspiracy theory Friday (FDA & CCHIT related)

Nov 1, 2009• 5

By Matthew Holt

Two fun things—First, Mark Leavitt says he’s quitting CCHIT in March. He says that he’ll be 60 then and wants to go do other stuff. Of course the cynics among you will say that he’s had enough of being beaten up by David Kibbe and Brian Klepper, and that CCHIT’s role as arbiter of meaningful use has been downgraded by David Blumenthal. Leavitt says in his outgoing email (not on any website I can find but I have a copy)

“Given the current high-strung health IT news environment, the media may seek to conjure up some sensation-worthy driver of this decision, but the fact is that I am simply keeping a promise I made to my family and myself to retire from full-time work within a certain window of time”

It also happens that this announcement comes the day after Blumenthal sends out an email to the Health IT world that Vince Kuraitis (at the very least) sees as a direct shot at large health IT vendors whose products don’t play nice with others (i.e. aren’t too interoperable) yet are already CCHIT certified. Here’s Vince’s take on who should have got that email.

Second, the twittersphere has been abuzz with a series of hearings where the FDA has been taking opinions on how and why they should regulate Pharma advertising in social media. this is a non-trivial issue for both sides. Pharma wants to reach patients, patients want those social media players to exist, and the sites need money (which will have to come from Pharma, unless something changes in the space time continuum). I don’t pretend to know the outcome except to remind you all (via Bill Silberg) that a similar meeting was held more than a decade ago and the result was….nothing. no guidance, no policy.

Spotlight on Health 2.0: In The Doctors Office, from SF 2009

Nov 1, 2009

Every week we bring you a new video from Health 2.0! This week we’re featuring Health 2.0 In the Doctors Office, a special showcase featuring physician-facing tools and services from the recent Fall conference in San Francisco.

To see more videos from past Health 2.0 conferences, or to purchase the entire conference DVD sets from ’07 & ’08 click here. 2009 DVD sets will be available shortly, please check back for updates.

Time to put aside the intellectual disputes for now

Oct 31, 2009• 75

By MATTHEW HOLT

It’s always fun to see my friends beating each other up in public….and if you read down in the comments on the post published yesterday you’ll see a significant dispute between Maggie Mahar and the Klepper/Kibbe/Lazsweski/Enthoven team (who I’m calling the Four Horsemen from now on). But I think that right now we need to change what we’re talking about.

I’m with Maggie in that there is potentially more in terms of changing the payment system in the current bills than nothing, but it’s not that much more than nothing. However, pressure from the the Four Horsemen and their fellow travelers on payment reform may increase that section of the bill as it gets worked out on the floor and in the Congress conference committee. Their pressure will also serve notice that aware, sensible people are looking at the issues of payment and delivery reform.

And at the least, the proposals in the bill don’t make the current delivery system any worse (other than the exemption from taxes for self-insured groups which clearly discriminates against integrated systems and must go).

Why McAllen Should Have Mattered in the Health Reform Debate

Oct 29, 2009• 45

By JEFF GOLDSMITH

Back in June, Atul Gawande, a Harvard trained surgeon, published a riveting article in the New Yorker about the physician community in McAllen Texas. If ever an article was strategically timed to influence the nation’s health policy debate, this was the one. His story was accompanied by a graphic showing a patient as an ATM machine. President Obama read it and put it on his staff’s reading list. Yet, it’s depressing how little impact Atul’s article has had on health reform.

Atul’s purpose was to explain a major policy conundrum: why some communities manage to spend as much as triple on Medicare services as other communities. McAllen’s physicians practice some of the most expensive medicine in the United States, second only to Miami, and spend seven thousand dollars per Medicare beneficiary more than the national average. Peter Orszag has said that eliminating this type of variation could cut Medicare expenses nationally by as much as 30% and actually improve the quality of care.

A Bill of Rights for Health Care Reform

Oct 29, 2009• 12

Our nation’s Founders created a pretty good system of government by starting from what they wanted to achieve, exemplified by the Bill of Rights, so perhaps we would be wise to base health care reform on a similar footing. Instead, Congress is doing its usual muddled process to produce legislation that is likely to make no one very happy, but at least tries to minimize the number of people made very unhappy. As is too often the case, it is easier to create straw men to attack than to address the real problems. Insurance companies seem to be everyone’s favorite target to demonize, but the “evil” health insurance industry is like the various other players in the health care system: responding to the numerous and often perverse incentives in the current system. There are bad things done to people by insurance companies — as there are done by doctors, hospitals, government, and just about every other player in the health care system. There are both angels and demons working in health care, but mostly it is just normal people. Perhaps ninety-nine percent of the people working in the health care system try to do right by the people they serve, but “doing right” may not mean the same thing to different people.

A Message to America’s Physicians: Purchasing EHR Technology A Shaky State of Affairs

Oct 28, 2009• 31

By Brian Klepper and David Kibbe

Much of the conversation and debate about physician EHR adoption has centered on the single issue of the (high) cost of purchase. However, we’d like to suggest that the situation is much more complex and involves several more subtle variables.

Consider, for example, uncertainty about the future. In a recent speech, Lawrence Summers, Director of the White House’s National Economic Council for President Barack Obama, related the following analysis about decision-making under conditions of uncertainty in the marketplace, which he had first heard from Ben Bernanke, current Chairman of the Federal Reserve, in a speech Mr. Bernanke gave over 30 years ago:

“If you as a business were considering buying a new boiler, and if you knew the price of energy was going to be high, you would buy one kind of boiler. If you knew the price of energy was going to be low, you’d buy another kind of boiler. If you didn’t know what the price of energy was going to be, but you thought you would know a year from now, you wouldn’t buy any boiler at all. And in exactly that way, it is illustrated that the reduction of uncertainty, through the resolution of disputes, is, I would suggest, all important, if we are to maintain confidence.”Continue reading…

Senate Health Care Reform: Two Huge Problems, One Giant Red Herring

Oct 28, 2009• 13

By ROGER COLLIER

Pity poor Senator Harry Reid. Not only is he facing an uphill reelection fight in Nevada, but as Majority Leader, he must reconcile the health care reform bills from the Finance and the Health, Education, Labor and Pensions committees so as to attract sixty Senate votes. He’s guaranteed support from the more partisan Democrats, but to attract Democratic and one or two Republican centrists without losing liberals, he has to find ways to deal with two huge problems with the bills—and one giant red herring.

The giant red herring is the public option, THE big stumbling block for reform, mostly thanks to the efforts of lazy-thinking doctrinaire politicians of both parties—especially in the House. (Yes, Speaker Pelosi and Minority Leader Boehner, I mean you.) The reality is that for a public option to provide an adequate network, its payments to hospitals and physicians must be at least at Medicare levels. As experience with Medicare Advantage shows, this means its costs will be close to those of private coverage or higher, especially if it adopts Medicare’s uncontrolled fee-for-service structure and attracts the least utilization-conscious providers and patients. All this makes nonsense of liberal claims that the public option is necessary to control costs, and equally, of conservative allegations that it will destroy the insurance industry—and leaves Senator Reid’s “opt-out” solution looking merely perverse.

Commentology

Oct 28, 2009• 2

Jeff Goldsmith writes:

As you may know if you’ve read my postings, I’m an outspoken advocate of tightening Medicare fraud and abuse laws. There will be a post on this in a day or two. It’s actually the stuff that’s legal that is the problem: doctors self-referring patients for radiological scans, surgery, hospitals admissions to facilities they have an ownership interest in. I think there is just as much “fraud” of this type- rampant self dealing- on the private insurance side.

The scandal is: what’s legal. And I stand by my earlier statement that the big money is in running up the tab on the privately insured, not in Medicare. On private insurers’ margins, I’ve never subscribed to the populist garbage about obscene profits. Uwe Reinhardt had an excellent analysis of the Wellpoint 10K the other day in the New York Times. Health insurance is actually not a very good business. Many of these firms would be a lot more profitable if they were better managed, and eliminated a lot of the paper and clerical overburden, and if they were more aggressive in bargaining with providers. Since the same companies process Medicare claims, I don’t see us escaping them. Management in both our private and public systems is mediocre and not improving. (Medicare has been without an Administrator for two years, spanning two administrations).

It’s really a waste of my time to participate in a philosophical BS argument about government=bad, private sector= good. That sort of ended after college for me. We have a mixed system. I’ve worked in both private and public sectors. If we want to cover the 55 plus population, my best case scenario is for Medicare to assume the insurance risk, and contract with well managed HMO type health plans to actually co-ordinate the care. We’ve both spend decades working in this field, Nate- 34 years in my case; I’ve spent most of my time in provider space, and have a much clearer idea than you do about where the waste is. Don’t get me started- if all you’re looking at is claims data, and in essentially one market, believe me, my friend, you don’t know what you don’t know . . .”

Glen Tullman on EMRs, life, the universe and everything

Oct 27, 2009• 1

By Matthew Holt

A couple of weeks back Allscripts’ CEO Glen Tullman was on the Cats & Dogs panel at Health 2.0 and he said some pretty controversial things about the state of EMR adoption (yes it was happening), certification of meaningful use (it was being diluted and the tax payer faced being ripped off) and other vendors, or at least one other vendor from small town Wisconsin that wasn’t playing fair in the quest for interoperability).

Given that I always enjoy talking to Glen and also that he’s as responsible as anyone else for getting Obama interested in the concept of why EMRs and automating health care matters (and therefore why there was so much money in both Obama’s campaign pledges and in the stimulus package for EMRs), I thought it would be fun to have Glen back on THCB to expand a little on what he told us at Health 2.0. And yes there was plenty more interesting stuff where that came from. (Be warned, the sound quality is not great, but its completely understandable)

Here’s the interview