Free Healthcare IT Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Get all the latest Health IT updates from Neil Versel for FREE!

ACA decision is a beginning, not an end, to health reform

I’ve spent a lot of time on social media since Thursday morning debating the meaning of the Supreme Court’s rather stunning decision on the Patient Protection and Affordable Care Act. It was stunning in that Chief Justice John Roberts, a George W. Bush appointee, sided with the four liberal-minded justices, but also stunning in that the court went against conventional wisdom by upholding the individual mandate on the grounds that it was a legal exercise of Congress’ constitutional right to levy taxes.

I had to remind a lot of people that this decision neither solves the crisis, as supporters have claimed, or turns us into the Soviet Union, as some on the lunatic fringe have suggested. Expanding insurance only throws more money at the same problem. This was my first tweet after I learned of the decision:

Breaking news: American #healthcare still sucks. It's quality, stupid. #ACA #hcr #SCOTUS #Obamacare
@nversel
Neil Versel

The cynic in me likes to point out that the individual mandate was an idea first conceived by the conservative Heritage Foundation and championed in Massachusetts by Mitt Romney. Both somehow now oppose the idea. The law that ultimately passed Congress was written by Liz Fowler, a top legal counsel to Max Baucus’ Senate Finance Committee who previously was a lobbyist for WellPoint. Her reward for doing the bidding of the insurance industry was for Obama to appoint her deputy director of the Office of Consumer Information and Oversight at HHS. This was insider dealing at its finest, as much a gift to insurers as the 2003 Medicare Prescription Drug, Improvement and Modernization Act was a gift to Big Pharma.

Of course, I initially was misinformed about the Supreme Court ruling because CNN jumped the gun (as did Fox News) and erroneously reported that the court had struck down the individual mandate on the grounds that it violated the Interstate Commerce clause of the Constitution. But so were millions of others.

I suppose that was fitting, since the national media have for more than two years been misinforming the public about what is really in the law. There are small but real elements of actual care reform — not just an insurance expansion — in there, but very few have been reported. The actual reform has been drowned out by ideologues on both sides. Here’s a handy explanation of most of what’s really there (it’s a good list but not exhaustive). The insurance expansion, the only thing people are talking about, really is just throwing more money at the problem. There is a lot more work to be done to fix our broken system.

What I consider real reform in the ACA includes accountable care organizations and the creation of the Center for Medicare and Medicaid Innovation. Along with the innovation center, CMS also gets the power to expand pilot programs that are successful at saving money or producing better outcomes. In the past, successful “demonstrations” would need specific authorization from Congress, which could take years.

Notice that there isn’t a whole lot specific to IT. That’s because the “meaningful use” incentive program for EHRs was authorized by the 2009 American Recovery and Reinvestment Act. Another key element of real reform that also is not part of the ACA is Medicare’s new policy of not reimbursing for certain preventable hospital readmissions within 30 days of discharge.

We need more attention to quality of care. Many have argued that tort reform needs to be part of the equation, too, because defensive medicine leads to duplicative and often unnecessary care. Perhaps, but lawsuits are a small issue compared to the problem of medical errors. Cut down on mistakes and you cut down on malpractice suits. Properly implemented EHRs and health information exchange — and I do mean properly implemented — will help by improving communication between providers so everybody involved with a patient’s care knows exactly what’s going on at all times.

All of these facts lead me to conclude that true healthcare reform hasn’t really happened yet. Look at this Supreme Court ruling as a beginning, not an end, to reform.

 

June 29, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Podcast: Carrie Handley on patient empowerment with an iPad

Did you happen to catch my story in MobiHealthNews on Thursday about Carrie Handley, the IT consultant-turned-cancer patient? She got frustrated with first a misdiagnosis and then the hassle of lugging around a binder full of paper records that she had to go to multiple sites to collect to assure continuity of care during her treatment and surgeries. So Handley digitized all her records.

Initially, she transported the information on a USB drive, but that got lost in a doctor’s lab coat. Then, her son brought over an iPad. The tablet provided the right balance of portability and shareability. In this interview, Handley, a resident of Waterloo, Ontario (you know, the home of BlackBerry maker Research in Motion), describes the process and shares her thoughts in general on mobility in healthcare.

We wouldn’t have connected if she hadn’t read my tribute to my dad last month. After reading Handley’s story in the e-mail she sent me, I knew we had to do this podcast to help spread the idea that communication can help foster the kind of patient-centric care that eluded my dad, that initially eluded her and that probably eludes millions of people every year.

This Sunday is Father’s Day. I miss my dad terribly. But I take comfort in knowing that I’m doing a small part to raise awareness of multiple system atrophy (MSA) — the rare neurodegenerative disease that killed him — and perhaps advancing the cause of patient safety ever so slightly.

Podcast details: Interview with health IT consultant and cancer survivor Carrie Handley about mobility in healthcare. MP3, mono, 128 kbps, 26.7 MB. Running time 29:13.

June 14, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Yes, you do have a right to your health records

Lest anyone forget — including the American Hospital Association, which wants to take 30 days post-discharge to supply copies of medical records to patients — HIPAA explicitly gives patients the right to access their own records. This is not new. The HIPAA privacy rules have been in force since 2002. Yet, far too many patients have no idea of this right and far too many providers don’t inform patients of this right or do what they can to prevent access.

Fortunately, the HHS Office for Civil Rights, which enforces HIPAA privacy and security standards, is trying to change that with an outreach campaign, including this video.

 

Unfortunately, the video has been viewed just 556 times as of this writing. Equally unfortunately, the video directs viewers to visit HHS.gov/OCR. But the real information you need is at http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html. I found that page using Google, not by trying to navigate the menu, which is not very intuitive, even for someone who knows the healthcare industry. I can’t imagine the average consumer finding that page without help or plain old dumb luck.

Various HHS agencies are trying hard to disseminate messages to the public. I think of AHRQ’s Questions are the Answer campaign. I’ve seen poster-size ads around Chicago telling people to visit ahrq.gov for a list of questions they should be asking their healthcare providers, but the better link, not mentioned in the ads, is ahrq.gov/questions.

For that matter — and I mentioned this to one of the AHRQ higher-ups at the HIMSS conference a few months ago — how many people really know what the Agency for Healthcare Research and Quality is? Wouldn’t it be better to have a more memorable URL? The Obama administration is good at setting up URLs for programs it wants to promote for political reasons — think recovery.gov and even the consumer-friendly healthcare.gov — but the less-politicized divisions such as AHRQ (remember, Director Dr. Carolyn Clancy is a career professional who has run AHRQ for two presidents since 2003) and OCR haven’t done so. They need to come up with easy-to-remember URLs that the general public can remember. Bureaucrat-speak just isn’t getting the job done.

Meantime, physicians need to become more patient-friendly, too. I invite you to check out this Salon article from a few weeks ago entitled, “Listen up, doctors: Here’s how to talk to your patients.” Please share with family, friends and, yes, your doctors. Share the OCR video, too. If OCR can’t make the information easy to find, I will.

 

June 12, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

MedAssurant is now Inovalon. Does Inova Health know?

Healthcare data analytics company MedAssurant today announced that it has changed its name to Inovalon. From the press release:

Inovalon is a newly coined term created by combining innovation, value, and action. Within the name are also key elements of the words nova and valor. ‘Innovation’ is not just a patented formula, but a signature form. It is built in causal sequence on three principles: Insight, Intervention, and Impact. ‘Nova’ conjures images of great energy and passion bursting forth, intensity of light, and a source of life. ‘Value’ is a cornerstone of the Company’s offerings and a commitment to its clients. ‘Valor’ conveys bold determination and integrity. And ‘On’ communicates a strong call to action.

OK, that’s a mouthful, and some branding consultant probably got paid handsomely to come up with that.

Thing is, Inovalon is based in Bowie, Md., near Washington, D.C. Right there in the same metro area, in Falls Church, Va., is integrated delivery network Inova Health System. (My educated guess is that the “nova” part comes from the fact that Inova is in Northern Virginia, often referred to as NoVa.) Will we find confusion in the marketplace? Worse, will Inovalon soon be getting a call from Inova’s lawyers?

 

June 5, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Health reform is so much more than insurance

The headline above shouldn’t surprise regular readers or anyone who knows me. I’ve been saying for a couple of years to anyone who asks me about “Obamacare” or any other aspect of healthcare reform—and many people who haven’t asked—that the public debate and media coverage have been about insurance reform, not care reform, and health insurance is not the same thing as healthcare. I’ve publicly chided the national media, too.

Maybe that is changing. Last month, attorney Philip K. Howard, chairman of advocacy group Common Good (an organization working to “fill the substance void in the 2012 election by offering new solutions to fix broken government”), wrote in The Atlantic that no matter what the Supreme Court does with the Patient Protection and Affordable Care Act, healthcare still will remain inefficient and expensive. “The Affordable Care Act, aka Obamacare, strives for universal coverage. While it encourages pilots for more efficient delivery systems, the overall effect is to exacerbate the unaffordability of American health care. In this sense, the upcoming Supreme Court decision on constitutionality is just a side skirmish,” Howard said.

In other words, as I’ve been arguing for two years, the insurance expansion of this supposed comprehensive “healthcare reform” legislation is simply throwing more money at the same problem. Having insurance doesn’t assure you good care, nor will it by itself even reduce overall costs. It just shifts costs. There was more reform in the HITECH section of the 2009 American Recovery and Reinvestment Act, in the form of the $27 billion incentive program for “meaningful use” of electronic health records than there is in the part of the ACA being widely debated in this election year.

That’s why, as I pointed out Friday, I was happy to see that investigative journalism organization ProPublica has started a Facebook community for people to share stories of patient harm. And today, the New York Times discussed actual healthcare quality in one of its Sunday editorials (h/t Jane Sarasohn-Kahn). The Times highlighted efforts at Virginia Mason Medical Center in Seattle, Cincinnati Children’s Hospital Medical Center and hospital alliance Premier, saying, “It is a measure of how dysfunctional the system has become that these successful experiments — based on medical sense, sound research and efficiencies — seem so revolutionary.” Indeed.

By the way, my recent, controversial post arguing that faxing should be considered malpractice isn’t a new thought I’ve had. I just rediscovered my January 2011 commentary in Columbia Journalism Review about media coverage of telephone-based “telemedicine.” I ended the piece by advising fellow journalists to “start asking the health-care organizations you cover why they still rely on old-fashioned telephones and fax machines.” Malpractice or not, legal or not, it’s more than a decade into the 21st century, yet we still view healthcare through a 20th-century lens.

Or, as I also like to say, it’s quality, stupid.

June 3, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Facebook community for reporting patient harm

Kudos to investigative journalism organization ProPublica (yes, some journalists still have integrity today) — and a hat tip to HealthLeaders for bringing it to my attention — for setting up a Facebook community for people to report stories of patient harm. I’ve just shared the story of my dad’s torturous final month. I’m glad that a news organization with wide reach beyond the healthcare and technology industries cares about real stories, not distractions related to insurance coverage and partisan politics.

The group now has 661 members. There really should be 1,000 times as many. Please join and share your own stories, then help get the word out about the poor state of U.S. hospital care. (Note that I only accept Facebook friend requests from people I know personally.)

June 1, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.