The Health Care Blog – Page 987 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Commonwealth puts the boot in, again

Jul 17, 2008• 8

By Matthew Holt

Veteran THCB readers shouldn’t need too much reminding about this, so I’ll spare you the blow by blow documented here over the years. Here’s the bottom line. Any time you do a trans-national study on health care, you find that the U.S. spends way too much and gets way too little in terms of quality and outcomes.

In doing these studies the Commonwealth Fund has become the bete noir of the political right.

Why? Well it starts with data first and then draws conclusions, rather than the opposite approach followed by most on the right. And whatever way you look at the data they’ve produced over the years, it’s clear that things aren’t going well.

Hospital rankings for positive press or for real?

Jul 17, 2008• 2

By Sarah Arnquist Wirehospitals

Hospital & Health Networks magazine announced America’s "100 Most Wired" hospitals for 2008 this week.

You can compare this list to the list of "top hospitals," as recently ranked by U.S. News and World Report.

Hospital & Health Networks created the "most wired" ranking a decade ago. This issue’s cover story says that wired hospitals have happier patients and higher quality measures than their less technologically advanced peers.

"Taken together, the patient satisfaction and quality indicator analyses
provide the strongest evidence in the 10-year history of the Most Wired
Survey and Benchmarking Study that information technology makes a
difference in both the patient experience and the quality of care."

Mr. HISTalk has a more cynical take on the ranking.

Interview with Trizetto & Eliza

Jul 16, 2008

By Matthew Holt

Due to poor planning on my part, this morning I was up scandalously early to talk with Gene Drabinksi, who runs the CareAdvance unit of Trizetto, and Alexandra Drane, President of Eliza.

Last week they announced a partnership that integrates the care management aspects of Trizetto’s services with the automated phone outreach provided by Eliza. It’s another step in the evolution of phone-based contact and personalization in health care — which, the careful THCB reader will have noted, I think is an important channel for delivering and capturing health information.

Of particular importance, is making useful that vast glob of data stored within a health plan by communicating about it with the members. It’s also always good to hear from some experienced and passionate players, and Alex and Gene certainly fit that bill. As I hadn’t had any coffee, I wouldn’t claim the same for myself!

Here’s the interview.

Health IT supporting our troops

Jul 16, 2008

By John Halamka Coin

I spent yesterday in Washington with Major General Elder Granger, Deputy Director in the Office of the Assistant Secretary of Defense for Health Affairs.

We discussed electronic health records, personal health records, decision support, and interoperability. Here’s a brief overview of the electronic systems supporting our troops. Go here for additional details.

AHLTA-T is a PDA version of the Department of Defense Health Record running on Windows CE devices. The DOD tests all of its battlefield technology at Fort Detrick for ruggedness in battlefield conditions — heat, sand, ice, water, and physical abuse. A shock resistant enclosure keeps the PDAs safe. The AHLTA-T record itself has an iPhone-like interface with radio buttons and touchable graphics to rapidly record a battlefield assessment. It generates a structured history and physical, then creates a care plan based on triage rules and best practice protocols. The user interface is designed to be easy to navigate in high stress conditions. Given the lack of WiFi and reliable cellular in battlefield conditions, cradle sync is used to transfer all the medical records to AHLTA system.

Once in AHLTA, battlefield data joins the patient’s lifetime health record and is available worldwide for clinical care. Patients may be evacuated to Germany and upon arrival, their entire updated record is available to the care team.

AHLTA data is transferred to a Clinical Data Repository where it is available for institutional review board approved clinical research, surveillance, and quality reporting. DOD leadership has real-time dashboards showing injury, biosurveillance, and medical supply data.

The DOD also has an integrated pharmaceutical repository with over 1 billion records from pharmacies and pharmacy benefit managers which dispense medications to the armed forces and their families.

When a patient leaves the armed forces and becomes a Veteran, their lifetime medical record is available in the Veteran’s Administration VISTA system via the Bidirectional Health Information Exchange (BHIE) built to connect the DOD and VA systems.

It’s an impressive system, incorporating national standards, serving our troops throughout their lifetime.

As I left, General Granger shook my hand and passed along his personal coin (photo above), just as Dr. Koop had done with me a few months ago.

I look forward to a productive collaboration between the DOD and the non-profit health care world I live in everyday. I’m confident there are decision support alerts/reminders, mobile device implementations, and data exchange experiences that we’ll be able to share for our mutual benefit.

The Managed Care Roller Coaster

Jul 16, 2008• 19

By MAGGIE MAHAR & NIKO KARVOUNIS

At a health care forum held last year in Las Vegas, then-presidential candidate Hillary Clinton declared that she was intent on “taking money away from people who make out really well right now” in order to fund health care reform. When asked exactly which fat cats she was referring to, Clinton responded, “Well, let’s start with the insurance companies.”

Clinton’s sentiment — that private insurers are making out like bandits while our health care system crumbles — is part of the received wisdom these days, especially among progressives who believe that for-profit health insurance doesn’t add much value to our health care system. But the reality is that in recent years, private insurers haven’t been doing so well financially.

Consider United Health Care (UHC), the nation’s biggest private insurer. Joe Paduda of Managed Care Matters reports that UHC will be cutting 4,000 jobs as part of a restructuring plan that includes eliminating Uniprise, one of its major brands. Since last fall, UHC stock has plummeted from $53 to $22 a share. WellPoint, another huge private insurer, has watched its stock drop from $82 a share in 2007 to $49 a share in June.

State telemedicine networks: a modern anachronism

Jul 15, 2008• 2

By Scott Shreeve

I continue to read with interest articles describing new telemedicine projects. I just don’t get it.

What are these guys doing? You don’t need a telemedicine network fraught with complicated hookups, poor screen quality, and difficult communication interfaces. The new telemedicine network is called the I-N-T-E-R-N-E-T (invented by Al Gore in 1994) which in case you didn’t know obviates your “telemedicine initiatives”. I mean seriously, who is sponsoring all these things anyway? Oh, it must be the really efficient guys who you want to sponsor your health care.

There are hundreds of services popping up that do this stuff all day long – American Well, TeleDoc, Consult-A-Doc, Myca, etc. The only thing encouraging I saw in this article is that they actually believe they can have a 100 clinics up the first year. That will be great so that the millions of people who have been doing eConferencing via the internet for the last five years can have some medical people to talk to. Cool.

Oh, and by the way, congratulations on the concept of a broadband connection. Maybe you can download some Seinfeld re-runs to celebrate the glory days of 1998.

The Two Ted Kennedys

Jul 15, 2008• 3

By Matthew Holt

I’m up at Spot-On explaining the Ted Kennedy Medicare miracle to the masses and suggesting that there are some real long-term problems that won’t be so easy for the Dems to solve later. As ever come back here to comment.

Well, lookee there: Congressional Democrats actually won one. That’s right. After 14 years of ignoring core liberal principles – including the last 18 months when they actually had a majority – they took on the Republicans and won.

How did this happen? Well, it’s an election year, and by forcing an issue that Congress has been putting off for years — automatic cuts in Medicare physician payments — Democrats seized the chance to score a few points.

Essentially, the Democrats decided that, instead of agreeing to another fudged compromise to put off the decision to cut payments, they’d set the insurers against the doctors. So they found the money to put off those automatic cuts by taking some away from private Medicare insurers. Now, it was a bit of a surprise that so many House Republicans joined them and drop-kicked the insurers with whom they’ve been aligned for so long, although of course they’re all up for re-election. But once there was a veto-proof majority in the House, the Senate Democrats realized that they could force the issue and score a political win.

Read the rest.

It’s all about the billing

Jul 15, 2008• 5

By Sean Neill

Sean Neill is a South African-born, British-trained anesthesiologist, who recently relocated to Midwestern USA. He blogs regularly at OnMedica about his cross-cultural experience, frequently pointing out oddities of American health care.

Having arrived to see the last of the winter snow, we were amazed at how quickly spring and summer evolved. Frozen pavements evolved to lush green grass in a matter of weeks. Work is a 10 minute cycle away and most Americans find it humorous to see you arrive at the hospital in cycling gear. When asking for directions, the reply is always in terms of driving, even if it is just around the corner. One quickly learns to cycle on the wrong (right) side of the road as the vehicles are so large you would not want to make a mistake.

Another noticeable difference between health care in the UK and the USA is in terms of billing. A UK patient can go into an NHS hospital for a big procedure and may not be asked for another penny. It is completely different in America, where charges start from the minute you walk in the door. Each hospital specialty has its own large team of dedicated professionals diligently chasing every possible expense. A short visit to a primary health care facility will be followed by a bill within days.

Already counting down to the next physician fee cut

Jul 14, 2008• 3

By Robert Laszewski

Robert Laszweski has been a fixture in Washington health policy circles for
the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. You can read more of his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog.

Is the "medical home" a real solution?

Now that this year’s fight over Medicare physician fees is all but over, it is important to turn to real solutions.

The recent Senate and House vote to kill the 10.6% physician fee cut only defers the problem for 18 months.

On January 1, 2010, the Medicare physicians are slated to get an automatic 21 percent fee cut!

More importantly, the Medicare physician fee structure is grossly out of whack with primary care docs starving under the current fee system.

War on terror becomes a war on the desperate

Jul 14, 2008• 3

By Matthew Holt

I don’t go off topic on THCB much these days, but I do so after reading about the arrests of illegal immigrants at a meat-packing plant in Iowa and the treatment of those arrested.

The “war on drugs” was ramped up in 1986 after a basketball star allegedly died from a cocaine overdose and has since been perverted into a budget-busting bonanza, going largely after marijuana users who are doing little harm to themselves or anyone else. But they are still being arrested in their hundreds of thousands, and contributing massively to the budgets of law enforcement and prisons nationwide.

It was entirely predictable that the same thing would happen to the “war on terror.” In order to justify the huge and growing budget of the Department of Homeland Security’s biggest agency, the Immigration and Customs Enforcement (ICE), illiterate illegal immigrants who are doing nothing more than trying to support their families are now being charged and jailed for laughable offenses using legislation put on the books to stop terrorists. The “war on terror” is now taking on the vital stronghold of rural Guatemala, via Postville, Iowa. The aim is clearly to justify ICE’s budget by pretending that illegal immigrants are serious criminals.

Just in case you thought the callous indifference of this Administration couldn’t get much worse, you should read the whole account from the interpreter who was at the court cases at Postville, Iowa. Hundreds of immigrants are being jailed for up to 5 months — at your and my expense — on the insistence of the DOJ and the ICE.

Here’s the whole account from interpreter Erik Camayd-Freixas, and I urge you to read it.