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Obama’s new ad is clever, but why aren’t they taking the open shot?

• 10

By Matthew Holt

One of the few virtues of getting on a plane and leaving California is that you get to see Presidential political ads on actual TV. Obama has a new ad about health care which explicitly attacks “government run health care” on the left of an arrow and then attacks unregulated insurance companies on the right end. Geddit? Yup it’s 1996 Bill Clinton all over again. The man is a triangulator. Or an arrownator…

(Apologies for the poor quality but it’s the only version I can find online).

Obama’s plan is in the middle of the arrow of course. It’s a little bizarre that he attacks government-run health care — given that his plan involves both extending FEBHP and creating a separate version of Medicare/Medicaid that everyone can buy into. And of course Medicare is the most popular health insurance plan in the nation by a long way. I think the government still runs it.

But I guess that’s just politics. And of course nothing as major as what he’s talking about is going to happen once he gets elected anyway, (as I’ve been saying for more than a year).

But talking about politics, what I cannot get over is how the Obama team has not bothered to connect the McCain plan’s designs to push more people into the individual insurance market to specific actions of health insurers in California. There are still smart intelligent people running major health care lobbying organizations in DC (one of who I had dinner with last week in my professional life) who still have not heard about the retroactive policy cancellations in California despite the fact that all of the big insurers were doing it. And yet McCain’s plan is designed to explicitly put people into a situation where they’re at the mercy of those insurers!

This isn’t hard to explain. Why isn’t the Obama campaign featuring it? Especially as he’s now talking about health care. They are not taking the open shot (or as the English say, they’re missing an open goal!)

Obama vs. McCain on health care

• 10

By Donald Johnson

Sen. Barack Obama’s attack on health insurance reforms proposed by Sen. John McCain shows that Obama’s not for real change in health insurance.

Obama wants more government-sponsored health insurance schemes, like
the VA health care system, Medicare and the unaffordable Medicaid scheme
that’s bankrupting the states and the Feds.

Obama wants to keep employers involved in the insurance markets,
even though they limit consumer choice, increase costs for consumers
and make their workers buy expensive policies they don’t want nor need.

Continue reading…

EMR implementation — a saving grace or year of hell?

• 8

By Shahid Shah

A friend of mine sent me this link – "Beware of the EMR ‘Ponzi scheme,’ warns physician leader" — earlier this week. The article starts off by saying:

Healthcare IT does not necessarily make life easier for
primary care physicians, says a leader in the movement to make medicine
more efficient and patient-centered.

"When you put an EMR into a primary care practice, your life is hell for the next year," said L.Gordon Moore, MD.

"EMR vendors aren’t really giving us what we need. We have to make a
distinction between a robust EMR with decision support tools, and one
that is just being marketed as a way to improve coding. And we really
need to get out of the E&M coding game."

Yikes. I’ve been in the health care IT market for a while and that’s
probably one of the strongest anti-EMR statements I’ve seen publicly.

I know many readers are physicians — how many of you concur with Dr. Moore?

Shahid Shah is a health care consultant, specializing in IT. He blogs regularly at The Healthcare IT Guy.

Reader mail: EMR advice from an IT insider

• 6

By THCB Staff

JD’s comment on a recent post was so excellent it deserved re-running.

Large medical systems generally have implemented EMRs while small, independent practices have not. It’s not a government or socialism thing. That 13% EMR penetration statistic masks a huge disparity between the bulk of physicians in 1-3 person practices and the minority of physicians in large practices (or at hospitals).

The EMR problem reflects on a larger problem of fragmentation in the US medical sector that serves no purpose for the larger public interest. The Mayo clinic manages to offer some of the highest quality care in the US, does cutting edge research, has some of the lowest rates of unnecessary resource utilization, and pays its doctors a salary. Those things are not accidentally connected (well, the cutting edge research part is).

Given the huge lift necessary to move physicians into integrated delivery systems, I’m not holding my breath that it happens soon. There are things that can be done with private practices, but they present challenges of their own.

One relatively unheralded effort I’ve been involved with is New York City’s Primary Care Information Project, which is providing a good, standardized EMR at highly subsidized rates (over 50%). These EMRs are equipped with public health-directed enhancements like connections to disease and immunization registries and reporting of HEDIS-like data. The plan is to link them in a health information exchange and allow for more sophisticated (and easy to administer) pay for performance or value-based payment. The physicians involved are in small private practices and public health clinics.

But it is a huge slog to get these physicians signed up in the small private practices. For some physicians, the comprehensive EMRs are almost free and yet you have to talk to 20 doctors to get a single one to sign up. It’s not just resistance to change. There is also an attitude among some that they’re making enough money as is, and doesn’t need to make any change. There is a resource problem: these offices have just a couple staff people who aren’t very technically proficient.

This is a big problem. Sometimes staff will undermine your effort to get in touch with the physician because they don’t want to be bothered, and also because they suspect (rightly) that their jobs may be in jeopardy. A large practice can reduce administrative FTEs by about 1 per physician. How this translates into a small private practice is a vexed issue. Do you fire one of the three staff people who have been working with you for years and feel like family? Or maybe your staff actually are family members. Sometimes the solution is to turn one staff member into a part time worker, though that can create its own dramas and problems for solo practices. But if you don’t let anyone go or reduce FTEs, you aren’t going to save money on your EMR.

Problems like this obstruct progress in EMR implementation less in a large institutional context where letting people go or retraining is easier, where tech support is a whole department, where people can spend time thinking about the strategic direction the EMRs serve and can engage in a formal RFP process to at least have a better chance of not getting stuck with a loser EMR, and where large capital investments can be more easily managed as part of the corporate planning process.

Please, can we now re-structure health care, too?

• 16

By David Kibbe

KibbeI respectfully disagree with my friends and colleagues who believe that the recent financial crises will make it more difficult to reform health care. In fact, now that we’re socializing large chunks of the financial system, we may find it a lot easier to socialize health service delivery assets, too. You’ll know a federal health system bailout is around the corner when you hear someone say, "The hospital is simply too large to allow it to fail."

Let me explain.

In the past three weeks we’ve all become regulators. Amazing. Almost overnight the federal government, we the taxpayers, have taken ownership of Freddie Mac and Fannie Mae, financial organizations that own about half of the mortgage debt in this country. We’ve nationalized AIG, one of the world’s largest insurance companies, and we are now owners of a large share of several of the country’s biggest commercial and financial banking institutions, with much more government transfers anticipated in the coming weeks and months.

Continue reading…

Reader mail: Pitfalls of EMR implementation

• 2

By THCB Staff

This recent comment about information technology implementation by a reader named Rob was so excellent it deserved re-running.

I’m a technologist. I’ve been implementing information technology
professionally for 25 years. I’ve been doing EMRs for the last five. There
are lots of ways this can go wrong, large or small.

1) Resistance: People hate change. Sometimes they’re correct. Most
often they’re a self-fulfilling prophesy as, without technologists
having support from above, and engaged knowledge from below, we end up
the scapegoat. You can’t computerize people. You can only make
computers part of their job. Just as you can’t make people fit a paper
form.

2) Hyper-acceptance: Problem-solving people with good intent come up
with brilliant ideas that ignore the basic nature of technology. Even
if you include all stakeholders, unless they trust a professional
technology staff, if they ignore good advice, if they simply order
technologists to do as they say, it won’t work. Information Technology
is really People Psychology, and the best of us know something about
both.

3) Technological Eeyores: A large percentage of technology
professionals are about the machine. They’re about the what and the
how. They’re not about the who. It’s easy to fall into the view that
the system was working perfectly before people got to it. Technology is
90% people. What are they doing? What is the real need? Can we do this
without adding a gadget? These are hard questions to ask, and the
broken and cynical among us won’t ask them. Sometimes they’re right
that no one will listen anyway.

It is said that technology is an artifact of all the compromises the
designers made to create it. I disagree. At its best, it is a living
thing that’s part of what people do; it’s an aspect of its users. It
can’t tell us what to do, though. Nor can it ask. This can all go
right, though. It can be successful.

That takes people. They’re expensive. That’s another thing. Can I,
in all candor, ask that we, as a society, stop seeking cheapness and
start seeking shared excellence? To me, that’s the real issue.

Half-baked Alaska: Palin short on health care explanations in debate

• 12

By Merrill Goozner

Merrill Goozner has been writing about economics and health care for many years. The former
chief economics correspondent for the Chicago Tribune, Merrill writes the blog Gooznews.com, where this post first appeared.

Palin

It must be disconcerting to health care economists to see one of their pet peeves about the inequities of the employer-based insurance system so poorly used by the Republicans, who would repeal it. I’m referring, of course, to the tax deductibility of health insurance premiums.

Gov. Sarah Palin repeated Sen. John McCain’s promise to give every American household a $5,000 check to buy health insurance. They would raise the money to fund the program by repealing the deductibility of employer-based coverage. I can’t recall if she gave one of her trademark winks when she said it, but she certainly gave an enthusiastic nod. Health care will become just like Alaska! The government will be sending you money every year so you can go out and buy your own insurance.

There is an argument that can be made in favor of repealing tax deductibility. Like the home mortgage deduction, the higher your tax bracket, the more valuable the tax deduction. So if your employer buys you a gold-plated health care plan that costs $15,000 and you’re in the highest tax bracket (around 30 percent), you get the equivalent of a $4,500 tax break from the government. But if your employer buys you a plan that only covers hospitalization and serious illnesses for $7,000 a year and you’re in the 10 percent income tax bracket, the tax deduction is only worth $700. Repealing all tax deductibility and distributing the revenue equally to buy individual insurance policies seems simpler and more equitable — both appealing traits.

Continue reading…

Hospitals going green

• 4

By Sarah ArnquistGreen

Hospitals generate 6,600 tons of waste per day, and about 80 percent of that is nonhazardous waste. There are lots of opportunities to get greener, and some hospitals really are making concerted efforts to do so.

While they might gain some positive PR from it, there is definitely a financial motivation to cutting energy costs and reducing waste.

Kaiser Permanente is promoting its new facility in Modesto, Calif. as one of the "greenest" hospitals in the country. The hospital saved $500,000 by using green building materials, according to a press release. It also has solar panels, asphalt parking that filters water, and supplies its cafeteria with locally grown produce.

The Green Guide published by National Geographic ranked the top 10 green U.S. hospitals in 2006, and indicated the trend was growing. Then this August, Hospitals & Health Networks Magazine’s cover story about green hospitals.

Practice Green Health has loads of good information and practical steps to make your hospital or health care facility more sustainable and efficient.

Obama’s Health Plan Under the Microscope and Through a Fair Lens

• 5

By MAGGIE MAHAR

Each presidential candidate offers a blueprint for health care reform. Neither can expect to see his plan enacted whole—legislators will leave their fingerprints all over any proposal. And, if truth be told, neither plan is perfect. Each proposal is blinkered in its own way; each ignores just how difficult true reform will be. I very much doubt that national health insurance will become a reality in the next year.

That said, I believe that we can take steps toward reform in 2009 if we begin thinking clearly—and honestly—about exactly what it is that we want and what it will cost. To that end, I believe that in-depth analysis of each candidate’s proposal can help underline the core ideological differences between conservatives, libertarians and progressives, and highlight the economic realities that any reform plan will have to face.

Recently, opponents of each plan have offered their critiques in Health Affairs (here and here) and supporters have defended their favorites here and here. Inevitably, many readers found the critiques too partisan. At the same time, they complained that rebuttals from the home team “read more like a stump speech with details glossed over and facts overlooked.”

Continue reading…

Help for newly unemployed to decipher COBRA options

• 2

By Sarah Arnquist

The downturn in the economy, means lots of newly unemployed individuals will be asking what happens with their health insurance.

There are a number of online resources to help them understand their options under COBRA. Here are a few:

eHealthInsurance launched a new initiative, www.COBRAlearning.com,
to education consumers about COBRA and alternatives health insurance
for the newly unemployed. Accompanying the launch, was a survey (paid
for by ehealthinsurance) that found many consumers don’t know what
COBRA is or what their options are after losing employment.

Besides having a cheezy name, bWell-Informed Health Plan Forecaster says it offers "vendor-neutral educational and personal underwriting tools" for those Americans who are in the position of having "the freedom, yet responsibility, to choose their own health care."

Here, also are government and nonprofit options. The Department of Labor explains COBRA coverage here. The American Cancer Society also has a page intended to explain COBRA coverage.

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