The Health Care Blog – Page 933 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Moving forward on SCHIP

Jan 30, 2009• 11

By Jocelyn Guyer

The Senate passed its version of legislation to renew the State Children’s Health Insurance Program (SCHIP) Thursday, bringing the bill very close to its long overdue White House signing ceremony. The new bill is expected to cover an additional 4.1 million uninsured children by 2013.

Most importantly, the new bill – like the old ones vetoed by President Bush – gives states new funding to sustain and strengthen their SCHIP programs. This will occur just in time, as families hit by the economic downturn look for affordable coverage options. It also gives states new tools to reach already-eligible, uninsured children and provides them with performance-based incentives to enroll them.

I’m thrilled about this bill. Not because I think it will solve everything, but because it will offer concrete help to many kids who need it now and can’t wait until we figure out comprehensive health reform.

It is fair to say, however, that not everyone shares my joy.

Uwe Reinhardt on why Canada is better

Jan 30, 2009• 4

By Matthew Holt

The master interviewed. (including transcript) Don’t worry—he only talks this way to piss off John Goodman, Stuart Browning and Newt Gingrich.

And in today’s scuttlebutt–Sutter pay grades

Jan 30, 2009• 4

By Matthew Holt

A little birdie contacted me leading me to wonder, what did the former CEO of Sutter Health Van Johnson do to get paid $5.6 million for working for a “part year” in 2006? (See page 100 of this PDF). It may go somewhat to explaining why a) Sutter is the most expensive hospital system in Northern California, and b) why the unions hate it so much! On the other hand we’re entitled to wonder when the web site says things like this :

Unlike investor-owned health care systems, Sutter Health is a not-for-profit organization. As such, any money left over after employees and bills have been paid is reinvested in health care.

On the other hand in 2005 Johnson didn’t make the top 5 list dominated by CEOs of individual Sutter hospitals all earning what typical hospital CEOs make—500K and up!) (page 59 here). Neither did current CEO Patrick Fry make the top 5 in 2007 (page 99 here). Perhaps the key is that they only pay the big boss after he quits?

Anyway, anyone who can elucidate please comment away.

Five Reasons For Hope

Jan 29, 2009• 17

By JOHN HALAMKA, MD

Over the past decade as a CIO, I’ve had successes and failures. I’ve learned about leadership in a crisis , how to resolve disputes, and how to serve my customers/employees/superiors . As I watch the first few days of the Obama administration, I have a great deal of respect for the initial activity, as seen through the lens of my own leadership experience. Here are five reasons I have great optimism for the new administration:

1. Smart People – Obama is surrounding himself with smart people, regardless of party affiliation or ideology. In my experience, A-level leaders surround themselves with A-level staff, since they are not intimidated by people who are smarter or more experienced. However, B-level leaders surround themselves with C-level staff who do not question the ideas and actions of their leader, resulting in sycophants rather than a strong leadership team. Of course, as we learned from Jimmy Carter’s presidency (he’s been a great post-president), the smartest people are not always the most successful people, but I have great faith in the new team!

2. Listening – As I’ve described in my blog about leading change , the most important part of Kotter’s principles is to build a guiding coalition. By engaging the stakeholders and listening to their priorities for change, Obama has created powerful grass roots momentum.

3. Doing the right thing – A wise person once said “When one bases his life on principle, 99 percent of his decisions are already made.” Should we drill for oil in the Arctic? Should government decide what therapeutic options doctors and their female patients can talk about? Should government decide science policy based on religious beliefs? The answers to these questions should be clear if we objectively ask ourselves what seems like the right thing to do based on the best objective evidence. The Obama administration is doing that.

4. Let the ideas flow – The web “democratizes data”. Ideas need to flow freely and as country we need to come to consensus about our priorities based on open and transparent communications. The Obama team, with the able assistance of Blue State Digital and other technology partners, has created Change.gov and Whitehouse.gov to reduce information silos.

5. Embrace technology – Obama is the first president to have a computer on his desk. Obama will keep his Blackberry. The communication systems in the Whitehouse will be upgraded to Web 2.0 technologies. Working with better technology will result in better,faster decisions and more enlightened management.

Will the Obama administration be perfect? No. Will the change management ahead be easy? No. Will we get to the right decisions faster and regain the respect of the world. Absolutely.

Have hope.

John Halamka is the CIO at Beth Israel Deconess Medical Center and the author of the popular Life as a Healthcare CIO blog, where he writes about technology, the business of healthcare and the issues he faces as the leader of the IT department of a major hospital system. He is a frequent contributor to THCB.

Calendar: The Smartest (Healthcare) Guys in the Room

Jan 29, 2009• 2

Filed under possible sleepers we're-keeping-an-eye on:

Alex Gibney, the Academy-award winning film maker behind the widely acclaimed "Enron: The Smartest Guys in the Room" will show segments of his newest film, a feature length take on Maggie Mahar's "Money-Driven Medicine" at the Families USA Conference in Washington D.C. this week. Directed by Andrew Fredericks. Screening open to the public. Wed. 8PM. Renaissance Mayflower Hotel. 1127 Connecticut Avenue. NW. IMDB entry here.

At Families USA, progressive optimism reigns

Jan 29, 2009• 4

By Sarah Arnquist

As an annual meeting of progressives should start, the Families USA conference of health advocates began in Washington D.C. this morning with applause and cheers of the announcement of President Obama's imminent signing of the Lilly Ledbetter Fair Pay Act and the anticipated adoption of a bill expanding the State Children's Health Insurance Program (SCHIP).

I missed the day's first talk by Sen. Charles Grassley (R-Iowa), who has been making headlines lately for his adopted role of Medicare kickback watchdog. (He's the only Republican I see on the agenda.)

House Majority Leader Steny Hoyer (D-MD) spoke next and promised successful passage of broad health reforms after the economic stimulus legislation is finalized. Vague on details, but full of enthusiasm gleaned from the opportunity seen in the current economic crisis, Hoyer said, "This is our moment."

"If we fail, if we have to revisit this issue in 10 or 15 years," he said, "I don't want even want to think about how bleak the picture will be then."

A Transparent Health Record

Jan 28, 2009• 9

By Adrian Gropper, MD

Transparency, in the form of a complete, patient-centered and accessible health record is a policy principle that can drive the next wave of health care innovation. Investing exclusively in institutional EHRs will further stifle efficiency, innovation and improvement. Web-based clinical summaries (CCR+DICOM+PDF) that are available for patient control foster patient-centered care, clinical collaboration, and research, and must be included in health care reform if we are to effectively improve provision of health care for patients and clinicians.We’ve been stuck on interoperability long enough to realize that EHRs are a tool and not a solution. To frame the problem, the National Research Council weighs in with a timely assessment and vision. A great summary by David Kibbe highlights the caution: “that current efforts aimed at the nationwide deployment of health care IT will not be sufficient to achieve the vision of 21st century health care, and may even set back the cause if these efforts continue wholly without change from their present course.” In the same vein, a recent Booz, Allen, Hamilton report, sponsored by the Federation of American Hospitals, reminds us that “Other countries experience shows that EHR adoption does not automatically lead to interoperability.”

How to read articles about health and health care

Jan 28, 2009• 17

By Alicia White

If you’ve just read a health-related headline that’s caused you to spit out your morning coffee (“Coffee causes cancer” usually does the trick) it’s always best to follow the Blitz slogan: “Keep Calm and Carry On.”

On reading further you’ll often find the headline has left out something important, like “Injecting five rats with really highly concentrated coffee solution caused some changes in cells that might lead to tumors eventually. (Not to mention that the study was funded by The Association of Tea Marketing)The most important rule to remember: “Don’t automatically believe the headline.” It is there to draw you into buying the paper and reading the story. Would you read an article called “Coffee pretty unlikely to cause cancer, but you never know?” Probably not. Before spraying your newspaper with coffee in the future, you need to interrogate the article to see what it says about the research it is reporting on. Bazian (the company I work for) has interrogated hundreds of articles for "Behind The Headlines" on the NHS health news Web site, and we’ve developed the following questions to help you figure out which articles you’re going to believe, and which you’re not.

A whole lot more Medicaid, but there’s a catch

Jan 28, 2009• 26

By MATTHEW HOLT

It looks like the stimulus package is going to spend a whole lot more on Medicaid AND subsidize the purchase of COBRA for laid off workers. Unlike the “let them eat cake” brigade who’ll decry this as extending welfare to the worthless, I have no problem with it. So long as it really is only a temporary measure,

But let’s be clear—Medicaid is dumb public policy. It’s divided between paying for care for the poor and paying for mostly long-term care for the elderly and chronically disabled, and also has subsidies for hospitals in poor areas thrown in. Then it has S-CHIP as its bastard relation. Furthermore, while the Federal government giveth, the states (which are broke but can’t borrow—California alone is $45 billion in the hole!) are by necessity going to have to take away.

A tale of two pilots

Jan 28, 2009• 2

By Bob Wachter

The pilot of the US Airways flight that crash landed safely in the Hudson River earlier this month after taking off from Laguardia Airport is rightly being praised as a hero. But how significant of an accomplishment was it, really? In 1977, the pilot of a KLM flight on the runway at Tenerife's Los Rodeos Airport faced a similar test of his decision-making skills. The outcome was very different.