The Health Care Blog – Page 926 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Raising the Price Before You Put It On Sale

Feb 23, 2009• 3

By ROBERT LASZEWSKI

The Obama budget team has made it clear they are going into the next federal budget process playing it straight on many fronts that the prior administration had fudged on. The
cost of the wars, the cost of adjusting the alternative minimum tax
each year to keep the middle class from falling into it, the cost of
disaster relief, and the cost of avoiding the otherwise automatic cuts
to Medicare physician fees because of the Sustainable Growth Rate (SGR) formula were all conveniently left out of the Bush budgets making them look a lot better than they really were.

Facing a $1.5 to $2 trillion deficit this year
you might as well throw the lot on the pile, get it over with, and
create an even greater imperative for change—a trillion here a trillion
there "and pretty soon it gets to look like real money."

In the end an honest accounting is all to the Obama administration’s credit.

But on the health care front anyway, it may also be very shrewd politics.

Betsy McCraker misses the point, again

Feb 23, 2009

By Matthew Holt

Not content with being the catalyst for the unleashing of a torrent of vitriol in the direction of those Milquetoast individuals who are in favor of better information systems in health care, in the mild expectation that it might improve care delivery, Betsy McCracker is back at it again. This time the NY Times prints her letter. And in it she says:

These changes will affect all of us, at the least by requiring that our treatments be recorded in a federally mandated electronic database and guiding the choices our doctors make. Yet no hearings were held, no expert witnesses called, no opinions gathered from patient advocates, doctors’ groups, the elderly or other stakeholders.

Apart from the fact that there’s no evidence of one “electronic database”, she’s missed a couple of things.

First, hearings, witnesses, etc, etc, have been held for on this topic for years, and witnesses were called in the weeks before the stimulus bill—Microsoft’s Peter Neupert among them. Peter may not be an expert in Betsy’s eyes, but I think most of us would concede that he knows something about the topic (even though much of his advice was ignored).

Secondly, Betsy McCracker seems to be missing a minor point. The Obama campaign was not shy about telling anyone who listened that they were going to spend up to $50 billion on health IT in the next five years. It was on their website, and talked about by their health care advisers non-stop, as the WaPo noticed in early December.

Why are we supposed to be surprised that they did what they said they were going to do? Isn’t that the point of democracy? So Betsy, who won the election?

Yelp: The Backlash Begins…

Feb 21, 2009• 4

By Matthew Holt

There's a pretty serious article about Yelp, which has become the dominant player in restaurant and
service reviews in the SF Bay Area, in a local alternative weekly The East Bay Express called Yelp and the Business of Extortion 2.0.

Now recently Yelp has seen a couple of its reviewers sued for reviews about health care providers (both chiropractors), and the issue about what reviewers can say online is probably still to be worked out.

But this article is about something much worse. It accuses Yelp of changing reviews, eliminating them, and generally breaching the church/state line between community and sponsorship.

And it goes both ways. Businesses that advertise get bad reviews “disappeared” and those who don’t find their good reviews are vanishing.

Disruption breaking out over at Scott Shreeve’s place

Feb 21, 2009• 2

Clayton Christensen's publisher is pressing me to read The Innovators Prescription and then interview him. Sadly I haven’t had the time to pay the book the attention it deserves. Messrs Kuraitis & Kibbe already did a review on THCB and probably said what I’d say, which was that like several other Harvard Business School profs, they got the problem right but the solution wrong. I’m on record from a couple of years back saying that Christensen’s guns are aimed in the wrong direction.

But to be fair my criticisms are pre-publication. Scott Shreeve has a great interview with Christensen’s co-author Jason Hwang (the late Jerome Grossman is also a co-author). and in this interview several of the incentive issues which concern those of us who understand how innovation gets stopped in health care, are addressed. Well worth reading.

A Randomized Trial of Niceness in the ER and Other Stories

Feb 20, 2009• 7

By BOB WACHTER

One of the great joys of a life in academic medicine is the opportunity to work with lots of very smart people. But one regret is that there is something about academia that tends to homogenize – faculty learn that, when it comes to competing for the next grant or promotion, it pays to be clever but relatively conventional. Sure, innovation is the coin of the realm, but out-of-the-box, quirky thinkers generally need not apply.

With one exception. I’d like to introduce you to the mind of Don Redelmeier, Professor of Medicine at the University of Toronto, and, to me, the most creative researcher in healthcare, perhaps all of science, today.

I came to know Don when we were both Robert Wood Johnson Clinical Scholars at Stanford University in the late 1980s, and we became fast friends. His eccentricities were obvious even then. Take, for example, Don’s algorithm for analyzing his dates, using a complex formula that assigned point values for intelligence, looks, humor, and tennis playing ability (bonus points). It wasn’t very romantic, but it was hilarious (we all looked forward to Monday recaps of the weekend’s events) and generally accurate. Continue reading…

Unpacking ARRA

Feb 20, 2009• 7

By Jane Sarasohn-Kahn

“The world changed yesterday at 1 pm Mountain time,” Steve Lieber, President of the Health Information Management Systems Society (HIMSS), told over 1,500 attendees of a webinar on February 18. These new times, Lieber said, “will require our vendor community to react a little bit differently and change business practices.” Lieber said that
health information technology vendors will need to be, in his words,
“more forthcoming” as well as “make absolute iron clad binding
agreements.”

The bottom line: time is of the essence, based the HIT details written within the 1,100 pages of The American Recovery and Reinvestment Act of 2009 (ARRA)…aka, “the stimulus bill.”

Lieber called ARRA, “the most important legislation to ever impact health IT.”

The amount of funding
related to HIT is about $20 billion. Never before in the American
health system has there ever been such an investment, especially at one
time, Lieber told those of us listening on the line. Some
money will flow in the current calendar year, some dollars will flow in
subsequent years, and some funding will be available until they are
completely spent.

Nine areas will receive HIT funding:

Skipping out on America’s future

Feb 20, 2009• 27

By Landon Gibbs and Brent Parton

Remember what it feels like to gorge yourself on a meal with friends only to find when the bill arrives, your tablemates have conveniently slipped off into the washroom? Well hopefully not, (if so, visit myfriendsareusingme.com) but young Americans should prepare themselves to feel such pain.

Despite all the excitement over the prospects of impending health care reform, the young still have reason for worry. While lawmakers from the Right and Left vigorously seek to caulk the wagon and float across the ideological divide on health care, little is being said about the sustainability of reform and its long-term implications for the future.

Divided we might get somewhere, but not yet

Feb 20, 2009• 7

By MATTHEW HOLT

The NY Times describes the Republican-less lobbyist meetings with Democrats that are allegedly getting
towards a consensus on an individual mandate as the way to universal health care. Funnily enough some of those same groups (e.g. The Business Roundtable & the NFIB) appear to be lessening their commitment to the worthily named “Divided we Fail” campaign.

And then on the second page of the NY Times article there’s this:

Many businesses, crushed by soaring health costs, say they now support changes in the health care system as a way to control their costs. But in its summary of the recent discussions, Mr. Kennedy’s office said, “There was little consensus on the employers’ role.”

Connecting the dots–Uninsured people are poor!

Feb 20, 2009• 10

By MATTHEW HOLT

A bunch of random articles all hit at once on Wednesday morning. And they win the John Madden award for stating the bleedingly obvious. This is kind of a companion piece to my rant about Friday’s NY Times article on the health industry and its political allies and adversaries sitting down to come to consensus.

Inquiry featured a worthy study. It tried to suggest that high costs “crowd out” health insurance spending.

Commentology

Feb 19, 2009• 2

John Haughton MD left this thought-provoking follow up to his original post on the Obama administration's health IT plans. ("Stimulus Bill Offers Docs Incentives, But Demands Effective Use")

"Since writing the post 2 weeks ago, the Stimulus bill has now passed. It does offer the $40K + bonus for "effective use" of a "qualified EHR" (DISTINCT FROM CURRENT DEFINITIONS OF EMRS / EHRS) – The bill specifically targets FIVE AREAs (which by the way are the evidence-based areas associated with HIT and care improvement): 1) Patient Info / History and Problem lists (Structured Data); 2)Clinical Decision Support. 3) Quality Reporting (performance measurement) 4) Ordering (including prescribing) 5) Interoperability (exchange and integrate with other sources).

All of the above can ENHANCE workflow and health by saving time and improviing care. There is no push in the bill to completely change office workflow – there is a push to enhance patient care.

The days of the $40K EMR are numbered. Here's a prediction: most physicians will spend no more than $10K each over a 3 or 4 year period (2010 – 2013) to acquire and use a qualified system – leaving an increase of dollars flowing into primary care – a great stimulus. What do you think?