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Above the Fold

Locating the “Medical Home”

There’s no doubt that people — especially those with (multiple)
chronic conditions — need a more holistic model for managing their
health needs than what our delivery system currently offers. The PCMH
model is intriguing, but I have worried that many examples of PCMH
deployment thus far have been centered around the physician’s office
(and, to some extent, the physician’s needs).

In contrast, most patients with health problems are living 24/7 with
whatever is affecting their quality of life, and not much of it is
spent in the doctor’s office. Think about it: There are 8,760 hours in
a year, and how many of them are spent in a health care facility?
Unless someone has multiple hospitalizations in a given year, the
answer is probably far less than 1 percent.

I’ve been fascinated for a long time now by the potential of Ix and
Health 2.0 strategies to deliver to us more robust models of truly
patient-centered medical homes than we have seen in most of the
country. Thankfully, other (smarter) people have also been thinking
about this and were able to join us to present in a recent webinar.

Continue reading…

Commentology

Former Medscape and Journal of the American Medical Association Editor Dr. George Lundberg had this response to Dr. John Haughton's opinion piece on government Health IT spending. ("Stimulus Bill Offers Docs Big Incentives but Demands Effective Use.")

"There are many reasons why physicians in general (excluding
pathologists, radiologists, intensivists, anesthesiologists,large
multi-specialty groups) have not yet embraced healthcare information
technology. I refer interested readers to for Blake Lesselroth's unique take
on the barriers to full clinician adoption of HIT
and how to overcome
some of them.

 Dr. Robert Rowley's post  on his company's advertising based  electronic medical record system ("Freenomics and Healthcare IT') prompted this response from Scott Shreeve MD

I was an early critic of Practice Fusion when I first heard of their business model. However, I have come around for many of the reasons that Dr. Rowley and Dr. Kibbe mention. In fact, I would suspect that I am the only commenter on this section that has actually used the software in to take care of patients (Crossover Health personal health advisory service).  Getting a tool (an EMR) into the hands of providers (much better than paper) who can use it to improve patient care is a good thing. The fact that the tool comes with some branded messaging is tolerated because the price (free) and the ease of use is so compelling (installed in minutes).

In terms of software, I have found the features/functionality of the software to be sufficient for now, the look and feel to adequate, and the rate of ongoing development to be intriguing (several key updates over last several months). There are definitely some holes that need to be plugged, some functionality that needs to be added, but overall I find it from an EMR perspective to be "good enough".

Continue reading…

Certification versus Meaningful Use

Halamka

Recently, clinicians have asked me “why should I implement my organization’s preferred EHR when I’ve found a less expensive vendor that promises meaningful use?”

This illustrates a basic misunderstanding of the difference between Certification and Meaningful Use.

The certification process will be codified in a December 2009 Notice of Proposed Rulekmaking (NPRM) and will define the process for certifying electronic health records including modular and open source approaches. (The Standards for data exchange will be codified in a December 2009 Interim Final Rule and become law immediately.) We know that ONC will specify certification criteria and that NIST will oversee certification conformance testing which will be performed by multiple organizations. However, we will not have the final certification criteria or the defined process until Spring after a period of comment on the NPRM.Continue reading…

Grand Rounds

Welcome to Grand Rounds. It's been quite some time
since THCB hosted the medical blogosphere's major compendium. So sit
back and enjoy a stroll through the gardens of medical and health care
obsession.

It's still a fresh political season, so we start with the wonks:

At TNR's The Treatment blog, Jonathan Cohn gets a top administration official to confirm
that health care will be a "central focus" of the budget proposal Obama
submits in a few weeks, signaling a major commitment to reform even
with Tom Daschle gone. He also runs down some possible successors to
Daschle and decides Howard Dean won't be the man, even though he'd do a great job.

Elsewhere on The Treatment, Harold Pollack says it's bad enough the U.S. opposes successful harm reduction strategies for drug addiction at home. Why do we have to use our clout to discourage other countries, too?

At Health Business Blog David Williams thinks that universal coverage
is a worthy goal, but says that if we get there by enrolling everyone in existing
public and private insurance schemes and maintaining existing levels of
utilization we’ll be doomed.

Continue reading…

Jon Cohn: Obsessed with baseball and a hopeless optimist

Jon thinks that Baseball Teaches Us (something) About Health Care Reform. Replace the star player with a bunch of utility infielders, and we’ll still win the pennant. Don’t worry Jon, Daschle isn’t the only one who came in with high hopes and didn’t make it through the week. So long Luiz Felipe!

But more importantly, unity (for the bailout) is a bust already, less than two full weeks into the Obama Administration with only 3 Republican Senators prepared to buck Rush Limbaugh, and then at a pretty big cost to the President and common sense. As Krugman pointed out today, bipartisanship is a crock, with the Republicans telling Obama to go whistle despite his bail-out package being less in total and way less in degree than a centrist Democrat would want. He left in all those tax cuts to please Republicans and they dissed it anyway.

So what would the Republicans do if serious health reform came up for discussion? I think I know! And if Obama starts with an already watered-down plan, it’ll just get more watered down.

How Goo-Goos Listen to the Grassroots

Back in December, after the Obama-Biden Transition Team encouraged individuals across the country to gather with friends and neighbors to talk about health care reform, I reported on My Health Care Reform House Party.

Turns out these Obamanians are far more serious goo-goos than I gave them credit for. Goo-goos, for you non-Chicagoans, are those earnest “good government” types with a deep and abiding belief in rationality in government. When the Obama team said it wanted the input of the masses into its health care reform plan, my brain translated that as, “What better time than the Christmas season to encourage earnest talk about the plight of the poor and uninsured.” But here we are approaching mid-February, with a President Obama playing for keeps with Congress, and the White House says it is doing both a qualitative and quantitative analysis of the feedback it received from ordinary citizens.

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Health Wonk Review

Up and kicking at the Health Business Blog. Don’t forget that the big kahuna of all these compendiums in health and medical blogging comes to THCB next Tuesday when we host Grand Rounds. (Yes, it’s the result of a bet which we lost!) Send your finest submissions to john at thehealthcareblog dot com. Please send us a link along with a HTML-ready synopsis of your piece. Third party nominations accepted! 

State of the Nation

Daschle out at HHS – Sharfstein in at FDA?

Oie_090203_daschle_634The early stages of the Obama administration are beginning to
resemble the Clinton years, which I 
observed from afar (I was a foreign
correspondent in Tokyo at the time). Take Zoe Baird and substitute Tom
Daschle, who dropped out of the running for Secretary of Health and
Human Services today because of tax and conflict-of-interest problems.
Take gays in the military and substitute putting in charge of the bank
bailout a man (Tim Geithner) who knows all the bankers from his years
at the New York Fed, seems overly solicitous to their needs, and has
his own tax problems.

Once again, a new Democratic president appears to have a semi-automatic weapon semi-permanently aimed at his foot.

Continue reading entry

The Case for Ron Wyden

Wyden_smile
Let me be the first to suggest that the President name Senator Ron Wyden (D-OR) to be the next 
Secretary of HHS. The
withdrawal by Tom Daschle has underscored just how important it will be
for the President to name someone who can bring a number of key
strengths to the job. All day reporters have been asking me whom the best person was for the
President to now turn to and get his health care agenda back on track.

Seems to me Ron Wyden fits the bill.

Continue reading “The Case for Ron Wyden”

Berwick “Perfectly Designed” for HHS Secretary Post?

Several well-informed sources independently told me that Institute
for Healthcare Improvement founder Dr. Donald Berwick had been chosen
by the Obama administration to run the Centers for Medicare &
Medicaid Services — a fascinating selection. (This article,
though, reminds us of Don’s background in public health and in
government commissions that deal with a broad swath of the policy
elite.)

But would Berwick continue to agree to serve under an HHS
secretary with less prestige, Congressional clout, presidential access
and deep understanding of health care than Tom Daschle? I’m presuming
here that Berwick already had a personal relationship with Daschle and
his senior advisers. Still, Berwick has spoken in recent months of
reform from “the inside out,” and there are few “insider” positions
with more influence over health care than being in charge of the
Medicare program.

Continue reading “Berwick “Perfectly Designed” for HHS Secretary Post? “

| Permalink
| Matthew Holt
Comments
(6)

Carmona could be logical pick for HHS job

Merrill Goozner
has been speculating about who will be nominated as the new Secretary
of HHS. He reviewed his most likely candidates (David Cutler or David
Blumenthal), and threw in a “dark horse” potential nominee: Ken Thorpe
(whom I’ve interviewed several times on this blog and spent time with during Obama’s inauguration ceremony).

Tommy Thompson told me that the nominee is likely to be a current or former democratic governor (such as Kathleen Sebelius or Howard Dean).

But I’ve been pondering the “long shot” question and think that
Goozner may have missed a more obvious choice – someone who works with
Ken Thorpe at the Partnership to Fight Chronic Disease: former Surgeon General Dr. Richard Carmona.

Continue reading “Carmona could be logical pick for HHS job”

The Perils of Play or Not Pay

Remember those heady days with a newly-elected Democratic President
and solid Democratic majorities in both houses of Congress, when it
seemed that national health care reform was just around the corner?
Remember how, after the face-off between the liberals who wanted a
single-payer system and the conservatives who wanted as little change
as possible, the centrists took command? Remember the early 1990s, and
play-or-pay as the magical way to universal coverage?

So you do
remember play-or-pay? Be careful about admitting it. After the failure
of the Clinton plan and the collapse of similar state reforms in
Washington and Massachusetts, a mere mention of the term would cause
political eyes to roll, while its inclusion in any reform plan was
enough to kill the proposal dead, dead, dead.

Continue reading “The Perils of Play or Not Pay”

Economics | Permalink
| Matthew Holt
Comments
(11)

Obama remains committed to health reform, White House official tells wonks

Lambrew
President Obama remains committed to comprehensive health care reform
in 2009 and believes the declining economy emphasizes its urgency, a
top White House official told hundreds of health policy experts Monday
in Washington D.C.

“The current economic crisis has really highlighted the problems and put them under fluorescent lights,” said Jeanne Lambrew, deputy director of the newly created White House Office of Health Reform.

The Academy Health conference
is probably the wonkiest of meetings on the increasingly crowded health
reform conference circuit. University PhDs and private sector policy
analysts are here to discuss and assess the impacts of reform.

Continue reading “Obama remains committed to health reform, White House official tells wonks”

Stimulus bill offers docs big incentives for technology, but demands effective use

6a00d8341c909d53ef010537105c50970b-800wiThe economic stimulus bills are a great step forward for health information 
technology and medicine.

The two bills, “HR1” and “S1,” continue to barrel down the legislative track and continue being amended, but as currently written they create real incentives for adopting certified electronic health records – upwards of $40,000 per physician starting in 2011.

The legislation emphasizes rewarding designs that improve care and create a path for certification of records with added functions, such as decision support, order entry, connections to other systems and reporting on quality measures. The bill focuses on implementation by tying the physician bonuses to proven, effective use. The stimulus package also formalizes the Office of the National Coordinator for Health information Technology (ONC).

Of the nearly $900-billion stimulus package, about $20 Billion would go to Health and Human Services, with $6 billion for the Office of the Secretary of Health and Human Services. Of that $6 billion, $2 billion would be for the Office of the National Coordinator (ONC) to support information technology.

Continue reading…

Commentology

The anonymous eDoc had this to say about Merrill Goozner's report that Obama may be considering Emory's Ken Thorpe as a replacement for Tom Daschle: 

"As a member of the Emory community, I know Ken Thorpe as a mover and a shaker in the area of public health with strong ties to the CDC (his office is literally next door to the CDC). He has Washington experience as Deputy Assistant Secretary for Health Policy during the early years of the Clinton administration, and has testified before Congress a number of times on public health issues. There is no stronger advocate for public health and preventative care than Thorpe."

Continue reading…

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