The Health Care Blog – Page 908 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Reconciliation — or War?

May 18, 2009• 9

By ROGER COLLIER

Reconciliation. It’s an odd word for something that could precipitate a knock-down, drag-out fight in Congress, but the process that Senate Democrats agreed last week to adopt if health care reform legislation isn’t passed by October 15 was originally intended to reconcile differences among House and Senate budget bills. What the process does is to replace the usual Senate requirement of a three-fifths majority—needed to end a filibuster, but also consistent with Senate traditions of compromise—by a simple majority.

So, with the Democrats having decided on an aggressive approach (Republican Senator Michael Enzi has called it “like a declaration of war”), what are the implications for the reform legislative process (beyond making Congressional Republicans mad)?

First, is October 15 an absolute drop dead date?

The answer is, not quite. Not only does the reconciliation process provide for up to twenty hours of debate (which could move the deadline out by just two or three days), but Senate Democratic leaders might prefer to continue negotiations on a reform bill if they felt they were close to the magic sixty votes. This would require the vote of at least one Republican, as well as the only Independent (Joe Liebermann), but would allow Democrats to claim bi-partisan support—even if only a little.

Marketplace

May 16, 2009• 1

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Calendar: Project HealthDesign

The Robert Wood Johnson Foundation (RWJF) has announced a new call for
proposals for Project HealthDesign: Rethinking the Power and Potential
of Personal Health Records, a $10-million national program to stimulate
innovations in personal health information technology. Project
HealthDesign will host the second of its informational web seminars for
potential applicants on
May 7th. For more information and to register: http://www.projecthealthdesign.org

Community: SharpBrains Releases 2009 Market Report

SharpBrains is pleased to announce the release of The State of the Brain Fitness Software Market 2009 report, their second annual comprehensive market analysis of the US market for computerized cognitive assessment and training tools. Designed for decision-makers at healthcare, insurance, research, public policy, investment and technology organizations this report contains important information concerning developments in the brain fitness and cognitive health space.

Octomum gives Kaiser a bellyache

May 16, 2009• 3

By Matthew Holt

First KP somehow gets landed with the Octomum, whom they most surely didn’t provided with the IVF in the first place. My assumption is that the multiple birth cost them into the middling 6 figures.

Now because a rogue employee released some of the Octomum’s records, they get hit with another $250K fine! I felt KP made a little too much fuss at the time about their services (the press conference crowing about the birth was a little much). But this is now an example of good deeds getting multiply punished….

SharpBrains Releases 2009 Market Report

May 16, 2009

SharpBrains is pleased to announce the release of The State of the Brain Fitness Software Market 2009 report,
their second annual comprehensive market analysis of the US market for
computerized cognitive assessment and training tools. Designed for
decision-makers at healthcare, insurance, research, public policy,
investment and technology organizations this report contains important
information concerning developments in the brain fitness and cognitive
health space.

The report this year expands to 150+ pages, and has added several new chapters:- Results from a market survey with 2,000+ respondents (decision-makers and early adopters)
– A proprietary Market & Research Momentum Matrix to categorize 21 key vendors into four categories
– 10 Research Executive Briefs written by leading scientists at prominent research labs
– An analysis of the level of clinical validation per product and cognitive domain

This insightful report will be available through direct purchase at a reduced rate for THCB readers strating May 7th, 2009.

Connecting finance to coverage

May 15, 2009• 20

By Matthew Holt

Repeating his message that Health Costs Are the Real Deficit Threat OMB Director Peter Orszag goes into the not exactly friendly territory of the WSJ Opinion pages and explains that practice variation is unnecessary and wasteful, comparative effectiveness research is a good idea. and that changing financial incentives for providers is necessary if we are ever to get health care costs under control.

The question is, how much of this gets included in the woffling coming out of Sen Max Baucus’ Senate Finance Committee? Here’s the press release on the options they’re considering. It’s a little like Stalin in 1930 saying, ‘the people are starving, we may collectivize the Kulaks, or we may rent them their farms back, or we may do nothing, or all of the above”. OK you may think I’m kidding but they give four different options for what a public plan may look like, six different approaches to small group and individual market reform (none of which deal with the smallest employers), and nothing about Orzsag’s concept of “changing financial incentives for providers”. Apparently that’s unrelated to insurance reform. (Yes yes I know they’ve floated some trial balloons about that too….)

What worries me is that because of the downturn and Orszag shining the light on the finance issue, we may have the chance to both fix coverage and finance. But I don’t see this all happening together.

So far I haven’t seen anything to change my mind about what’s going to come out of this process. So to bore all of you still reading I’m going to repeat what I said when I reviewed Tom Daschle’s (remember him?) book Critical.

So my guess is that the Federal Health Board, if it gets established, will get defanged by lobbyists immediately. The consequence of that is that the mish-mash of an “expand what we got now” system will cover a few more people at a lot more cost (as has been the Massachusetts experience). That’s OK because suddenly we’re rich (or at least suddenly the government is pretending it is!). But in a few years the stimulus will end and health care costs will have kept going up. Then we’ll realize that due to more cuts in Medicaid & subsidies for the working poor, and continued cream skimming and bad behavior by private-sector health plans, enough people have fallen through the cracks of the incremental expansion that we’ll be back where we are today again.

CODA: Click here to have some fun as to what happened when Baucus lined up 13 Democratic economists to talk about health care to his Committee and somehow couldn’t find even one who was in favor of single payer…

UPDATE from the FRESH-Thinking Capstone Conference

May 15, 2009• 2

By TEAL PENNEBAKER

In the same week that the Obama Administration has stated its commitment to overhauling the health care system, the FRESH-Thinking Capstone Conference adjourned yesterday morning to discuss next steps in health care reform. The event is a cross-section of health care experts—academics, practitioners, economists, industry insiders—devoted to fixing the health care system.

The morning began with Stanford Health Policy core faculty member Victor Fuchs welcoming the hundred plus attendees. Fuchs is co-director of the FRESH-Thinking Project with Ezekiel Emanuel. Emanuel stepped down from the Project to join the Obama Administration earlier this year. The Project has spent the past years considering all aspects of health care reform, and this conference is the capstone event of the group's findings. The morning talks look at the cost side of reform.

The first morning speaker was John B. Shoven, Director of the Stanford Institute for Economic Policy Research (SIEPR), who queried the crowd "is it possible to put health care on a diet?" Shoven's focus was on universal coverage and how it can be paid for. After discussing the logistics of who the uninsured are and the current taxation approach, he disavowed the crowd of two giant universal health care reform myths: shared responsibility and the middle class not having to shoulder health care costs. Shoven's take aways were "it's not necessarily that we should have new value added tax. It's that we should have a dedicated tax … We should not separate the benefits from the costs."

Should Health Care Standards be Open Source?

May 15, 2009• 10

By ALAN VIARS

Recently there has been some chatter on Twitter about health standards and open
source, so I thought I would write a little commentary on the topic.

Anyone who knows me well, knows that I am huge fan of Linux and open
source. This is perhaps why I get so frustrated with the US health
care industry and its general lack of interoperability. I could use
many standards as an example, however, for this discussion I’m using
the ASTM Continuity of Care Record (CCR) as an example. Now I’m not
picking on the CCR. The format is XML (good), and while there is always
room for improvement, I think the general structure is reasonable and
workable. I’d also point out that David Kibbe and Steven Waldren, two
keep champions for the CCR, have always been nice and helpful any time
I’ve asked a question on the list serve. I’m using the CCR as example
just because the barrier to access is so low ($100). Much of the
following is summarized from an inquiry I made to the CCR list serve
about a year ago.

The Chronic Pain Educational Educational Workshop in Berkeley, CA – July 19th, 2009

May 14, 2009

In the spirit of Health 2.0 and User Generated health Care we are proud to announce:

“The Chronic Pain Educational Educational Workshop"
July 19th, 2009 – 12:00P.M – 7:00P.M – Reception 7:00P.M – 8:00P.M

Chronic pain is the 21st century’s invisible handicap, a humanitarian crisis of epidemic proportions.

Chronic pain holds back individuals, families often whole communities from their full potential.

We believe effective chronic pain prevention and treatment is possible;
it comes through education and our goal is just to do that: to raise
awareness and educate on the issues related to chronic pain. That way
individuals and their families can make educated decisions on how to
manage their chronic pain, reclaim their lives and be able to
participate and contribute to their families and communities not longer
being devastated by daily burden of chronic pain.

The event is designed to educate and fundraise on issues related to
chronic pain and to benefit "The Chronic Pain Educational Documentary
Series."
During the event there will be informational booths with educational
material available to attendees, informational sessions and a silent
action. Food and beverages will be available.
Massage therapists will be available during the event for free chair massages.

Companies and individuals are welcome to sponsor and/or attend the event.
For more information or press releases please inquire via e-mai; at Ch******************@***il.com

Op-Ed: Leave it to Darwin?

May 14, 2009• 16

By ROGER COLLIER

I’ve been reading some of the testimony on delivery system reforms from the House Ways and Means Committee meeting earlier this month, in particular the lengthy statements from MedPAC Chairman Glenn Hackbarth and Urban Institute Senior Fellow Dr. Robert Berenson. Hackbarth and Berenson are each distinguished health care figures, and their remarks are worth careful study. Together, they paint an all too familiar gloomy picture of a system whose costs are out of control, in which quality is often poor, and where there is little correlation between expenditures and outcomes. Few would disagree with the causes that they identify: payment structures that reward volume, lack of coordination among providers, an overemphasis on specialty care, and a system that seems more often driven by supply than demand. The two sets of testimony include several very important recommendations, like more emphasis on public health, dissemination of comparative effectiveness information, and higher payments for primary care (although several years will elapse before this makes a real impact on physician career choices).

Other testimony proposals, however, especially those focused on
Medicare, carry the risk of distracting us from more important changes.
Chronic care coordination (including the medical home model) has not
yet convincingly been demonstrated to cut costs. Accountable care
organizations (this year’s buzz-phrase) require more willingness to
cooperate than many providers have so far shown. Bundled
hospitalization payments make good sense but require the same kind of
willingness to cooperate. Tying payments to quality introduces
questions of data interpretation and validity of guidelines.

Connecting value to coverage: a first glimpse

May 14, 2009• 2

By MICHAEL PAINTER

Would you take a virtual walk with me across the Dartmouth Atlas map on RWJF's web site? Just follow the link. Now, move your cursor first over, say, anywhere in Minnesota. There, you'll see that 2006 Medicare reimbursements were roughly $6,700 per beneficiary. Now, move your cursor across the country, way over to Massachusetts–specifically, Boston, for instance. There, 2006 Medicare reimbursements were almost a whopping $3,000 per beneficiary higher. You'd sure think that the quality of care in Massachusetts must be extraordinarily better for that extra $3,000 per person–but, guess what? It's not–it's roughly the same–maybe even worse in some cases. Plus, Massachusetts has embarked on its own universal coverage experiment. First in its class, Massachusetts is providing the rest of us with a real-world unfolding example demonstrating how health care cost, quality, value, and coverage intersect. If Massachusetts could figure out how to pay for high-quality care at the level of, say, Minnesota, their coverage experiment might just get exponentially easier.

So, are our national leaders taking this unfolding lesson to heart? We're beginning to learn. Last week the Senate Finance Committee released a set of policy options on transforming the health care delivery system. Their statement is really the first glimpse we've had at how our national leaders might (or might not) be linking value and coverage.