"Drug Makers Fight Stimulus Provision"
"Lobbying War Ensues Over Digital Data"
The first was a recent and the second headline comes from the Washington Post. Both refer to what were supposed to be two already agreed on health
care reform ideas–comparative research about which treatments work
best and the creation of a nationwide system of medical records.
The lesson here is that in health care nothing is easy, simple, or widely agreed to.
What would you call health care software that:
I call this Clinical Groupware. The term captures the basic notion that the primary purpose for using these IT systems is to improve clinical care through communications and coordination involving a team of people, the patient included. And in a manner that fosters accountability in terms of quality and cost.
With the conference report available on the web, here are the references to the health care provisions in the conference report of the 'stimulus' bill. I have not gone into great detail on the privacy provisions (which are, in large part, dedicated to a new aggressive federal watchdog/ punishment regime to enforce the privacy standards– that have not been developed yet).
Nor have I done a complete look at the COBRA and Medicaid expansion provisions.
But, make no mistake, this may be called a 'stimulus' bill— but it is really a massive expansion of the federal health care bureaucracy.
In light of all the discussion about the Economic Recovery Plan and
the privacy provisions in the HIT Title, I thought it might be helpful
to provide a consumer advocate’s view. The National Partnership for
Women & Families leads a coalition of consumer, patient, and labor
groups, the Consumer Partnership for eHealth (CPeH). The organizations
in this coalition are working to advance HIT adoption, because we know
that achieving better coordinated, higher quality health care demands
the integration of new technologies into the health care delivery
system.
From time to time we check in with my pal Frances Dare who is Cisco’s optimist about the impact that IT will have on health care (FD I’ve worked for Cisco in the past). Here’s an interview I did with her on HC IT policy last year.
Her handlers sent me this piece of video where she was interviewed about the role Cisco’s version of connected health could play in improving hospital efficiency. (Warning—you need to log in and give Cisco your email to see the video and once you get there I recommend skipping the first 3 minutes of corporate-marketing speak and wind straight onto Frances)
Meanwhile, I went on a tour last week of the Kaiser Garfield Center (which was very cool even though I haven't gotten around to writing about it yet!) and on it I was reminded about the role connectivity has to play in hospital design. As well as reaching out to the home.
Jay wrote in on Dr. John Haughton's post on the health IT provisions in the latest version of the stimulus package. ("Stimulus bill offers docs big incentives for technology, but demands effective use.")
"While a move to EMR is a necessity to reduce medical costs for the
country, I don't believe that providing purely financial incentives for
individual doctors is going to bring about the desired change. So many
doctors are already operating as small business owners so going through
the selection, procurement, integration and ongoing maintenance of an
EMR system is going to be both time consuming and expensive, much more
so than the $40K in incentives.
How many doctors are going to be a position to effectively wade
through the sea of EMR systems to find one that will integrate as
painlessly as possible with their clinical activities. By my judgment,
not that many. At the same time, what happens when a particular system
fails to meet expectations or fails outright; is the doctor paying
someone to be on the phone to work through the technical issues? How
much support is the doctor going to receive as just one small user of a
product?In my mind, a far better solution and use of the funds would be for
a centralized application commissioned by the federal government."
Stuart wrote in on the same thread, with an alternative suggestion:
Omitted in the "stimulus" bills is EHR using very secure, patient-carried EHR smart cards. They are well-proven, safe, easy to use, effective and in wide use in the EU. The French card system gets especially high marks.
But why ask our EU friends for a proven system when we can waste $20B screwing around for years with web-based systems that are so insecure that Americans will never agree to their use?
Most discussions regarding health care focus on parts that need fixing. Health care has many parts and some are broken and some aren't. But if we want to solve the problem, first we better decide on whether we have the right model. In the model that follows, we strongly emphasize building trust between participants but, as always, trust has to be verified.
Several years ago, we had the idea of building a non-adversarial managed care system for large employers and their injured workers. We named it "The Managed Care Alliance." As people familiar with workers' compensation know, it is among the most adversarial medical systems in the world. Employers and payers have little control over medical care and attendant costs. Abuse was rampant and providers, patients, and payers were pitted against each other. Many cases ended up in the courts. Our theory was that by eliminating friction, we could better ensure appropriate care for patients and significantly lower costs. Over a 10 year period during which I was involved, that is exactly what happened.
Browsing through some 2007 entries in Bob Laszewski’s Healthcare Policy and Marketplace Review blog recently, I came across Bob’s rave review for a health care reform proposal from the National Coalition on Health Care.
The National Coalition, for anyone unfamiliar with the organization, is (or ought to be) a health care reform powerhouse. Members of the Coalition listed on its website include the AARP, General Electric, Duke Energy, UnitedHealth, the AFL-CIO, Michigan Blue Cross Blue Shield, the American College of Surgeons, the California Public Retirement System, the Episcopal Church, and the Salvation Army—a remarkable cross-section of business, health care, and social and community organizations.
Individual supporters listed include such BIG political names as former Presidents Jimmy Carter and George H. W. Bush and former Senate majority leaders Bob Dole, George Mitchell, and Tom Daschle, as well as health economics luminaries Henry Aaron, Stuart Altman, Arnold Relman, Donald Berwick, and Uwe Reinhardt. It’s hard to imagine a more impressive list, or one with more potential firepower in the battle for reform.
The Coalition was formed in 1990, just as reform was becoming one of the top items on the national political agenda. It was established as a non-profit, non-partisan organization, with—in the words of its early materials—“members united in the belief that America needs better, more affordable health care and that all Americans should have health insurance.”
By Sarah Arnquist
In the grocery business, volume counts. Profit margins of mere pennies comprise the bottom line, and so health care costs rising at nearly double-digit inflation rates threaten to undermine the grocer’s business model.
Hence, one of the nation’s largest supermarket chief executive officers has his sights set on reducing rates of obesity among his 200,000 employees.
Safeway CEO Steve Burd looked at the numbers and concluded obesity is the root of a majority of his company’s health care costs. The way he sees it, chronic conditions, such as heart disease, diabetes and cancer, are his primary cost drivers. Obesity is behind them all.
Relying on his steadfast belief in the efficiency of markets, Burd led his self-insured company in 2005 to create a health plan that puts healthy behavior incentives squarely in front of his employees.
In the three years since, Safeway’s health costs increased only a half a percentage point, Burd told an audience of hundreds of health services and policy researchers last week in Washington D.C. In that time, most businesses have experienced about 16 percent increases in family premiums.
If I worked on the editorial board of a “news” organization that was owned by a lunatic from South Korea
who is a convicted criminal whose cult has been justifiably accused of kidnapping beating, and enslaving its followers I would be very, very, very careful before I started comparing the people who support an improved national health care IT infrastructure to Hitler and suggesting that they advocate mass slaughter of sick people.
But then I don’t work for the Washington Times. But even a written comparison isn’t enough.
They actually put a picture of Adolf Hitler next to their “editorial”.
Hat tip to Neil Versel and others who are as disgusted as I am
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