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Anonymous Reader Murry Ferris writes in:

I am a 65 year old retired ad exec and also an insulin-dependent
diabetic.  I have other medical complications, but taking care of the
diabetes is the big one.

Every day I test my blood glucose
levels as many as ten times.  A box of test strips retails for between
$40-$60 and lasts less than a week…. you do the math.  In case you
were not aware, your glucose levels are in a state of constant flux
depending on your intake of food and exercise.   Bottom line, keep your
levels, "level" and you'll lead a more normal life.

Now with all the
talk about raising taxes to pay for the rising cost of health care I
hear absolutely no discussion about reining in the unjustified
increases of medical supplies and equipment.   Just ten years ago I
could buy test strips for $10.   Now they come in slick PVC canisters,
wrapped in four-color labels and packed in plush slick cardboard boxes
stuffed with layers of "instructions" and phony code strips.   Remember
all you need do is stick your finger an put a drop of blood on the end
of the strip.   How hard is that?

So, for $2,600 a year I get to
stick my finger ten times daily, throw a pile of unread and expensive
packaging in the trash, and pay increasingly higher health care
costs.

Practice Fusion gets investment from Salesforce.com

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By MATTHEW HOLTBy default 2

We’ve been keeping tabs on Practice Fusion since the early days and THCB regulars will have noticed several comments and an article from CMO Robert Rowley. CEO Ryan Howard’s been hinting for a while that they were going to be getting into bed with a major software player, that shared their SaaS approach, and today they announced an investment from Salesforce.com, who we also know has been sniffing around health care too. This will include Practice Fusion becoming part of the Force.com (kind of an app store for the Salesforce.com ecosystem, although my guess is that few physicians are going there right now to look for records (not sure they’re going to Wal-mart either, though)

Practice Fusion is claiming that 19,000 users are already on its system which includes basic practice management, as well as a pretty complex EMR workflow. Coming soon will be a greater ability to share information with patients and other physicians over the platform—which allows it to spread via viral marketing. i.e. I’m referring you this patient, click here to get their data and sign up for this free EMR too. It’s not yet CCHIT certified, but Howard is aiming to be eligible for “meaningful use” money when the criteria are finally established.Continue reading…

Finally, A Reasonable Plan for Certification of EHR Technologies

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By DAVID C. KIBBE and BRIAN KLEPPER

A caution to readers: This post is about methods for certifying Electronic Health Record (EHR) technologies used by physicians, medical practices, and hospitals who hope to qualify for federal incentive payments under the so-called HITECH portion of the American Recovery and Reinvestment Act (ARRA). It may not be as critical as the larger health care reform effort or as entertaining as Sarah Palin, but it WILL matter to hundreds of thousands of physicians, influencing how difficult or easily those in small and medium size practices acquire health IT. And indirectly for the foreseeable future, it could affect millions of American patients, their ability to securely access their medical records, and the safety, quality, and the cost of  medical care.

Three weeks ago, on July 14-15, 2009, the ONC’s Health IT Policy Committee held hearings in DC to review and consider changes to CCHIT’s current certification process. The Policy Committee is one of two panels formed to advise the new National Coordinator for Health IT, David Blumenthal. In a session that was a model of open-mindedness and balance, the Committee heard from all perspectives: vendors, standards organizations, physician groups, and many others.

And then, on July 16, they released their final recommendations on what is now referred to as “HHS Certification.” The effects of their recommendations – these are available online and should be read in their entirety to grasp their extent – are potentially monumental, and could very positively change health IT for the foreseeable future.

At the heart of these hearings was the issue of who will define the certification criteria and who will evaluate vendors’ products. Among many others, we have voiced concerns that the Certification Commission for Health Information Technology (CCHIT), the body currently contracted by HHS to perform EHR certification, has been partial to traditional health IT vendors in defining the certification criteria, and in the ways certification is carried out, and thereby able to inhibit innovation in this industry sector. Despite its leaders’ claims that the certification process has been developed using an open framework, CCHT’s obvious ties to the old guard IT vendors have created an overwhelming appearance of conflict of interest. That appearance has not been refuted by CCHIT’s resistance to and delays in implementing interoperability standards, or by its focus on features and functions over safety, security, and standards compliance.

In the hearings that led to the recommendations, longtime IT watchers were treated to some extraordinary commentary, much of which dramatically undermined CCHIT’s position.

“HHS Certification means that a system is able to achieve government requirements for security, privacy, and interoperability, and that the system would enable the Meaningful Use results that the government expects…HHS Certification is not intended to be viewed as a ‘seal of approval’ or an indication of the benefits of one system over another.”

In other words, as the definition of Meaningful Use is now tied to specific quality and safety improvements and cost savings that result from health IT — among them e-Prescribing, quality and cost reporting, data exchange for care coordination, and patient access to summary health data — HHS Certification will closely follow. Rather than pertain to an EHR’s long list of features and functions, some of which have nothing to do with Meaningful Use, certification will be focused on each IT system’s ability to enable practices and hospitals to collect, store, and exchange health data securely.

Who Determines the Certification Criteria

The Office of the National Coordinator – not CCHIT – would determine certification criteria, which “should be limited to the minimum set of criteria that are necessary to: (a) meet the functional requirements of the statute, and (b) achieve the Meaningful Use Objectives.” As regulator, funder for this project, and a major purchaser of health services, the government, not users or vendors, will now determine HHS’ Certification criteria.

A New Emphasis on Interoperability

“Criteria on functions/features should be high level; however, criteria on interoperability should be more explicit.” That is, functions/features criteria will be broadly defined, but there will be a greater focus in the future on the specifics associated with bringing about straightforward data exchange.

Multiple Certifying Organizations

ONC would develop an accreditation process and select an organization to accredit certifying organizations, then allow multiple organizations to perform certification testing. In other words, the Committee recommended that CCHIT’s monopoly end.

Third Party Validation

The “Validation” process would be redefined to prove that an EHR technology properly implemented and used by physician or hospital can perform the requirements of Meaningful Use. Self-attestation, along with reporting and audits performed by a Third Party, could be used to monitor the validation program.

Broader Interpretation of HHS Certification

HHS Certification would be broadly interpreted to include open source, modular, and non-vendor EHR and PHR technologies and their components.

These bold, forward-thinking proposals from the HIT Policy Committee have not been accepted yet. But in our opinion they should be. These measures would encourage new technologies to enter the market for physician medical practices seeking EHR technology, and wrest control away from the legacy health IT vendors that have maintained barriers and delayed adoption, so you can be sure that the old guard players are doing everything possible to have them rejected.

But these are hugely progressive steps in the right direction, toward allowing HIT to enable improvements in care and cost efficiencies that would be in the best interests of users and the public at large. If implemented, the changes recommended by the HIT Policy Committee would create greater choice, more standardization, lower price, less interruption of the practices — as well as a check from CMS or Medicaid each year to help smooth the implementation, starting in 2011.

David C. Kibbe MD MBA is a Family Physician and Senior Advisor to the American Academy of Family Physicians who consults on health care professional and consumer technologies. Brian Klepper PhD is a health care market analyst. Their collected collaborative columns may be found here.

The Case for Taxing “Cadillac” Healthcare Coverage

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By CLAYTON MCWHORTERClaytonMcWhorter1

With President Obama’s plan for healthcare reform recently being dealt a tough blow by the Congressional Budget Office over soaring federal deficit projections, I am beginning to wonder if it is time for the President to modify his stance against taxing “Cadillac” healthcare coverage offered by employers.  It’s no secret what Senator Max Baucus, the Democratic Chairman of the Senate Finance Committee and one of the most powerful people in the healthcare reform debate, thinks President Obama should do.  Senator Baucus has been a vocal advocate of taxing healthcare benefits.  He recently told reporters that taxing employer-sponsored benefits is “the best way to raise money for an overhaul of the healthcare system.”  He has also been somewhat critical of President Obama’s decision to not tax healthcare benefits by saying, “Basically, the president is not helping us.”

In recent days, the Congressional Budget Office (CBO) estimated that the House Democratic legislation would add more than $230 billion to the federal budget deficit.  On the Senate side, Senator Baucus, who has been working with Senate leaders to formulate another plan, has pointed out the difficulties his committee has had with funding reform without some other type of significant revenue.

One way that raises enough revenue to cover well over the $230 billion figure projected by the CBO is through taxing employer-sponsored health benefits.  The nonpartisan Joint Committee on Taxation estimates that taxing employer-sponsored benefits above the value of the Federal Employees Health Benefits Plan (FEHBP), adjusted for inflation, would generate nearly $420 billion over the next 10 years, which would easily fund the difference in the budget gap.  Many other estimates place this number considerably higher.  Furthermore, many experts believe that this policy is a key way to reduce costs, because tax-free benefits encourage more spending on health care.

About 18 months ago, as I worked with a committee that I chaired in Tennessee called the Rolling Hills Group to create a structural model for national healthcare reform, I ran into the same problem that President Obama is facing today.  How do you pay for reform?  After considering several options on how to finance universal insurance, our group kept coming back to the same, single solution – the same one that Senator Baucus is a proponent of, taxing “Cadillac” healthcare benefits.

Under our proposal, we created a basic level of coverage similar to what members of Congress are offered today, known as the FEHBP standard option plan.  This plan is very generous and has been successful in holding down costs compared to other plans.  In order to make sure our plan was budget neutral, we decided we would no longer allow what we consider “Cadillac” coverage benefits to be tax free.  For example, in 2009, under our proposal, any individual policy worth more than $5,871.84 or any family policy worth more than $13,445.64 would be subject to a tax.  Anything less than this amount would be tax free.  For individuals, any amount above the base value of the plan would be considered income.  While for companies, any amount above the base value of the plan would no longer be deductible as a business expense.

We had this idea vetted by the Moran Company, who said that our plan is actuarially sound and budget neutral for the federal government once fully phased in.  Just as a note, in our plan we also derive revenue from Disproportionate Share Payments (DSH) and hold down up front costs by phasing in the reform over a 10 year period.  Disproportionate Share Payments is funding that hospitals receive for treating indigent populations.  Thus, it is reasonable to decrease DSH payments as the uninsured population decreases.

If taxing “Cadillac” coverage raises enough revenue to make healthcare reform budget neutral and encourages less spending on healthcare, why has such an attractive option for reform been pulled off the table amidst the President’s insistence on urgency?  As is usually the case with healthcare reform, the answer may be in the politics.

In recent weeks, several articles have outlined strong opposition by labor unions to the taxation of their healthcare benefits. In the Washington Post, the AFL-CIO stated its opposition to taxing “Cadillac” coverage.  Michael Sullivan, the President of the Sheet Metal Workers Union, has also adamantly stated his opposition to taxing healthcare benefits by saying, “Any bill that taxes health care benefits is dead on arrival.” Understanding these political difficulties, but still seeing the taxing of benefits as a viable way forward, lawmakers have demonstrated that there may be room for compromise.  Senator Baucus himself has hinted that he might consider grandfathering in the taxation of health benefits that are part of a collective-bargaining agreement, which would allow union plans to remain tax-free until new contracts can be negotiated.

Labor unions are not the only ones who have come out against the taxation of “Cadillac” plans, as many large corporations have exhibited significant opposition as well.  However, if healthcare reform is going to happen this year, Congress and President Obama may want to take a harder look at taxing “Cadillac” healthcare benefits as a means of raising revenue and achieving their other healthcare priorities.  I think it is fair to say that if Obama explains to the American people that the Government is only going tax the most lavish of benefits, he might find greater support from the American public for the change in health care that he promised to bring and that this nation so desperately needs.

Clayton McWhorter is a former President and chairman of HCA and current chairman of Clayton Associates and the Rolling Hills Group.  He is the founder of the group SHOUTAmerica, a Nashville based organization that uses social networking and other internet-based technologies to push for change in the healthcare system.

Are “Cadillac” health plans the problem?

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By BILL KRAMER

The debate over proposals to tax health insurance plans is confusing and frustrating.  The proposals are  usually described as a tax on “gold plated” or “Cadillac” health coverage.  According to the media and many spokespeople on the Hill, these health plans with “overly generous benefits” supposedly encourage overuse of medical services and drive up the overall costs of health care.  People express outrage that Wall Street executives have expensive tax-subsidized health benefits that include coverage for cosmetic surgery.  Is this really a problem?  If we fix this, will it raise lots of revenue and bend the cost curve?  I don’t think so. The problem is not “Cadillac” coverage, whatever that is.

I know that some economists believe that people ought to have more “skin in the game” by paying a significant share of the costs of medical services they receive.  I agree, but only up to a point.  Health care services are not like other goods and services.  If you give me more money, I might build a fancier house, buy a new car, go to more concerts, fly first class, etc., because I like all of these things.  Frankly, I don’t particularly like going to the doctor, and I wouldn’t spend my extra income on more blood tests, CT scans, colonoscopies, or surgeries (ouch!).   It’s fine to have modest copayments to discourage unnecessary doctor visits or to encourage use of generic instead of brand name drugs, but onerous cost sharing when someone is seeking medical care won’t solve our problem.  A tax on “Cadillac” plans won’t raise much revenue, and it won’t bend the cost curve in any significant way.

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Health-Care Reform and the “Culture Wars”

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By MAGGIE MAHAR

Friday, Politico.com editor Fred Barbash posed this question to “Arena” contributors: “Does the ongoing debate about healthcare reform reflect a :”kind of culture war” that can be traced to a “fundamental difference in world views?”

Barbash then pointed to a thought-provoking piece by Bill Bishop, titled “Health Debate Runs Along Familiar Lines” which was published on Politico.com in March.  Bishop, who  is the co-author of “The Big Sort: Why the Clustering of Like-Minded America Is Tearing Us Apart,” argues that “The health care discussion reveals that the country is still divided along lines drawn more than 100 years ago. . . divisions in the country were never about specific issues . . .. They were about ways of looking at this world (and the next), and those century-old differences are now shaping the health care discussion.”

Bishop frames the age-old religious debate this way: “Do you get to heaven by your good works, by what you do for your brothers and sisters on Earth? Or do you find salvation by your individual relationship with God? Does the world get better through public acts or private ones?“When Sen. Jim DeMint (R-S.C.) said recently that ‘this health care issue s D-Day for freedom in America’ he was talking from one side of this division. President Barack Obama says,  ‘I am my brother’s keeper.’ That’s the view from the other bank. “This isn’t a policy issue or a disagreement about strategy,” Bishop adds. “It is a fundamental difference in worldview. It’s a division in what people expect out of life, and it’s been part of this country for more than 100 years.”

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Senate Healthcare Bill Amendment Allocates Your Tax Dollars To Quacks

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By DR. VAL

With healthcare costs spiraling out of control, and major rationing efforts under consideration – can we really afford to allow purveyors of pseudoscience to use up scarce Medicare/Medicaid resources? It’s hard to imagine that Obama’s administration would approve of extending “health professional” status to people with an online degree and a belief in magic – but a new amendment would allow just that. What happened to our “restoring science to its rightful place” and why are we emphasizing comparative effectiveness research if we will use tax dollars to pay for things that are known to be ineffective?I hope someone reads and removes this amendment pronto (h/t to David Gorski at Science Based Medicine):Here’s the language that Sen. Harkin has slipped into the 615 page Senate version of the health care reform bill:

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Op-Ed: Health in All Policies

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By SUSAN BLUMENTHAL, MD and DENIS CORTESE, MD

At the heart of current health care reform discussions – which focus on expanding access to care and  establishing mechanisms to finance broader coverage as well as reduce rapidly escalating costs – must be the promotion of good health and the prevention of disease.
 

Good health is essential to the economic prosperity and wellbeing of the American people. Individually, we are less productive when we become ill; collectively, our nation is less secure when burdened with the high cost of disease. Today, with 45 percent of Americans suffering from a chronic condition and a national fiscal crisis, both our nation’s health and economic security are in peril.

Deteriorating health is a major driver of this crisis. One in five Americans smoke and 66 percent of adults are obese or overweight, fueling a chronic disease epidemic and skyrocketing health care costs. As childhood obesity rates dramatically rise, American children may, for the first time ever, live shorter lives and be less healthy than their parents.

Just as Americans are ailing, so too is our health care system. The U.S. health care system suffers from considerable fragmentation, inefficiencies and inequities. The United States spends nearly twice as much on health care, per person, as any other nation, and the health sector constitutes one sixth of our economy. Yet this significant investment delivers shockingly poor results. America ranks 49th on life expectancy worldwide, 37th on overall health status and performs the worst among industrialized countries at avoiding premature deaths through timely and effective medical care.

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