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About those Obamacare numbers and the ICD-10 delay

While I’ve been busy writing a couple of stories on different topics, you’ve probably heard two pieces of news that will affect healthcare providers nationwide: the close of the first open enrollment period for Patient Protection and Affordable Care Act insurance exchanges and the Congressional “fix” (read “Band-Aid”) to the Medicare sustainable growth rate that statutorily delays the ICD-10 compliance deadline for another year, until October 2015.

The White House yesterday reported that 7.1 million people had signed up for health insurance through healthcare.gov or state-run exchanges, barely exceeding the Congressional Budget Office’s projection of 7 million. Independent tracking site ACAsignups.net says it’s more like 7.08 million, but still just above the goal. That site also tallies the following sign-ups as a result of the ACA:

  • 6.37 million – 12.45 million in private “qualified health plans” (plans that meet ACA standards) via private exchanges, insurance agents or direct purchases from insurers, including deductions for the estimated 3.7 million whose “noncompliant” policies were canceled;
  • 4.71 million – 6.49 million through Medicaid/Children’s Health Insurance Program expansions;
  • 2.5 million – 3.1 million “sub-26ers,” young adults whom the ACA allows to stay on their parents’ health insurance until age 26; and
  • 1.8 million “woodworkers,” those who came out of the woodwork because they did not know before the Obamacare enrollment push that they were eligible for Medicaid or CHIP.

ACAsignups.net places the total range at 14.6 million – 22.1 million as of March 31, not counting the healthcare.gov numbers, though my math puts it at 15.38 million – 22.06 million. Add in the healthcare.gov sign-ups and you get about 22.5 million to nearly 29 million newly insured people. However — and this is a big however — we do not know how many of the beneficiaries are newly insured and how many were replacing previous coverage.

Personally, I bought a high-deductible, ACA-qualified health plan through an independent agent to replace a rather restrictive high-deductible plan that was grandfathered in, and should save about $70-$80 a month on premiums starting in May. The new insurer rejected me several years ago due to a pre-existing condition; the ACA assures that I can’t be denied for that reason anymore. I imagine there are millions in the same boat as I am.

The U.S. Census Bureau placed the number of uninsured for 2012 at about 48 million, or 15.7 percent of the population. (The same year, 198.8 million had private insurance.) Until we see new figures for uninsured Americans, we will still just have “gross” statistics, not a net figure to show if the insurance part of the ACA is working.

By the way, the ACA is about much more than insurance coverage, despite what the national media have focused on. I encourage you to read up on this before you say Obamacare is saving or ruining our country.

Now, as for the temporary SGR fix, the ICD-10 delay kind of came out of nowhere last week when it got slipped into the House version of the legislation, but the Senate adopted the same language — reportedly without debating ICD-10 at all — and President Obama today signed it into law. I’ve said before that ICD-10 and other transactional elements of healthcare stopped mattering to me as I watched my dad being mistreated in a hospital due to broken clinical processes in his last month of life. I still think this way. However, this sneaky move shows that the AMA, AHA and other groups more intent of protecting the status quo than fixing healthcare still have enormous sway in Washington.

It makes me wonder whether lobbyists haven’t already started pushing hard for Congress to delay the Medicare penalties for not achieving Meaningful Use that are due to kick in next year. Actually, I don’t wonder. I’m sure it’s happening.

All delaying real reform of a broken industry does is prolong the agony, and ensure that millions more people will be affected by errors and neglect in institutions that are supposed to “do no harm.” The status quo is not acceptable.

 

April 2, 2014 I Written By

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

Top 10 things wrong with Fox News smear job on EHRs

Today, FoxNews.com published a hit job on health IT and EHRs in the guise of another hit job on Obamacare. I found out about it courtesy of this tweet:

First off, it’s clear that Mostashari feels unshackled from having to watch his words now that he’s no longer national health IT coordinator. Secondly, he’s right. This story contains so many errors and misleading statements that it’s almost funny. Let’s count down the top 10.

10. “Under a George W. Bush-era executive order, all Americans should have access to their medical records by the end of 2014, part of a concept referred to as e-health. President Obama then made electronic medical records (EMRs) central to the success of the Affordable Care Act”

When Bush issued the executive order in 2004 that created the Office of the National Coordinator for Health Information Technology, he set as a goal interoperable EMRs for “most” Americans. The “all” part came after Barack Obama took office in 2009.

9. Though Obama did reiterate the 2014 goal and up the stakes by saying “all Americans,” nobody realistically thought it could happen. After all, the HITECH Act, which created Meaningful Use, didn’t pass until March 2009 and Meaningful Use didn’t even start until 2011. Before the HITECH Act, ONC barely had any funding anyway. For five years, Congress failed to pass much in the way of health IT legislation, even though a federal EHR incentive program had bipartisan support, symbolized by an unlikely alliance between Newt Gingrich and Hillary Clinton.

8. “Doctors, practitioners and hospitals, though, have been enriching themselves with the incentives to install electronic medical records systems that are either not inter-operable or highly limited in their crossover with other providers.”

Meaningful Use was never intended for enrichment, or even to cover the full cost of an EHR system.

7. While systems mostly are not interoperable yet, that wasn’t the intent of Stage 1 of Meaningful Use. Stage 1 was meant to get systems installed. Stage 2, which has barely started for the early adopters among hospitals and won’t start for 2 1/2 months for physicians, is about interoperability. That’s where the savings and efficiencies are supposed to come from.

6. We’re years away from knowing whether Meaningful Use program did its job, though I don’t fault members of Congress such as Sen. John Thune (R-S.D.) for putting pressure on the administration to demand more for the big taxpayer outlay.

5. “‘The electronic medical records system has been funded to hospitals at more than $1 billion per month. Apparently little or none of that money went to the enrollment process which is where the bottle neck for signing up to ObamaCare’s insurance exchanges appears to be,’ Robert Lorsch, a Los Angeles-based IT entrepreneur and chief executive of online medical records provider MMRGlobal, told Fox News.”

The money wasn’t supposed to go to the insurance enrollment process. The Meaningful Use incentive program was from the HITECH Act, part of the 2009 American Recovery and Reinvestment Act. The Patient Protection and Affordable Care Act, a.k.a. Obamacare, came a year later. Again, someone is confusing insurance and care. They are not the same thing.

4. “Lorsch, at MMRGlobal, offered the U.S. government what it describes as a user-friendly personal health record system for one dollar per month per family – a fraction of what it has cost the taxpayer so far.”

MMRGlobal’s product is an untethered personal health record. No untethered PHR anywhere is “user-friendly,” which is why adoption has been anemic. Without data from organizational EHRs, PHRs are worthless. Besides, the direct-to-consumer approach in healthcare has failed over and over, since people are used to having someone else — usually an insurance company — pick up the tab.

3. For that matter, MMRGlobal is a bad example to use as an alternative to EHRs. (The Fox story is correct in saying that other vendors do have close ties to the Obama administration, though the former Cerner executive’s name is Nancy-Ann DeParle, not “Nance.”) I could be wrong, but I haven’t seen a whole lot of evidence that MMRGlobal isn’t much more than a patent troll.

2. “But this process could have been easier if a nine-year, government-backed effort to set up a system of electronic medical records had gotten off the ground. Instead of setting up their medical ID for the first time, would-be customers would have their records already on file.”

Actually, as I wrote in a story just published in Healthcare IT News, we could have had national patient identifiers 15 years ago, as called for by the 1996 HIPAA statute. But Congress voted in 1998 not to fund implementation of a national patient ID and President Bill Clinton signed that into law. Since then, interoperability and patient matching have been mighty struggles.

1. “‘Plus, unlike under ObamaCare, the patient would be in control of their health information and, most importantly, their privacy,’ Lorsch said.”

Where in Obamacare does the patient lose control of health information? Less than a month ago, I was in Washington listening to HHS Office for Civil Rights Director Leon Rodriguez say, ““There is a clear right [in the HIPAA privacy rule] not only of patient access, but patient control over everything in their records.” This may come as news to some people, but patients own and control the information. They might not know it, but the language is pretty clear.

Already, the Fox story has been reposted in a number of blogs shared all over the Internet, so it’s being accepted as fact in some quarters. If you want the truth, you sometimes have to do the work yourself.

October 15, 2013 I Written By

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

About that Friedman editorial

Did you happen to catch Thomas Friedman’s commentary in Sunday’s New York Times entitled, “Obamacare’s Other Surprise”?

On first read, I gave it a big “Duh!” for the explanation that the Patient Protection and Affordable Care Act (that’s how the law is officially known, Mr. Friedman) creates a “new industry” of innovation by encouraging the federal government to release of terabytes of health data — information already legally in the public domain — and then allowing the private sector to figure out how to structure, interpret and use the data. As you probably are, I’m well aware of digital health, Health Datapalooza, federal CTO Todd Park and some of the companies Friedman mentions. (Health Datapalooza IV is less than a week away.)

But on second read, I realized Friedman needed to write that column because America needs a lot of education about the Affordable Care Act, education that the Obama administration and its supporters don’t seem all that willing to provide. The public still thinks of Obamacare largely in terms of health insurance coverage. It’s much more than that, including, as Friedman points out, an attempt “to flip this fee-for-services system (which some insurance companies are emulating) to one where the government pays doctors and hospitals to keep Medicare patients healthy and the services they do render are reimbursed more for their value than volume.”

Coupled with the 2009 American Recovery and Reinvestment Act, which created the $27 billion EHR incentive program for “meaningful use” of electronic health records, the ACA takes some steps toward actual reform of actual care, not just insurance coverage. Friedman does not discuss Accountable Care Organizations, an experiment in realigning incentives around care coordination, nor does he mention the Medicare policy, dictated by the ACA, of not reimbursing for preventable hospital readmissions within 30 days of initial discharge for certain specific conditions, currently heart attack, congestive heart failure and pneumonia. Likewise, he fails to bring up outcomes research, another component of Obamacare. But at least he gets something out there that’s not about insurance coverage.

Unfortunately, many of the online comments posted in response to Friedman’s commentary predictably focus on insurance coverage or government control, but some actually discuss EHRs, population health, healthy behaviors and payment incentives. That’s good. Still, those are just people who read Friedman and the Times. Hyperpartisan conservatives — probably even some hyperpartisan liberals, even though the ACA is more centrist than a lot of folks wish to admit — and the less-educated won’t read the column and won’t comment on the Times site. Those are the people who misunderstand this imperfect but occasionally reform-minded law the most.

 

May 27, 2013 I Written By

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

DoD-VA integration failure is no laughing matter, even to Stewart

Last week, I had a clip from “The Colbert Report” because Dr. Eric Topol appeared on the show to discuss digital health in a lively segment with Stephen Colbert. (I reported on it for InformationWeek Healthcare. The editors told me to have fun, so I did.) This time around, I’m going to give Jon Stewart equal time, not because I feel like having more fun with “fake news,” but because the host of “The Daily Show” had some insightful comments about the failure of the Military Health System and the Veterans Health Administration to get their EHRs to interoperate.

Though his job is to make people laugh—and ostensibly to upset conservatives—Stewart has been an outspoken advocate for America’s veterans, and when he heard the Obama administration has created a massive backlog for disabled veterans to receive VA health benefits, he went off. As far as I can tell, he got everything right, too.

April 1, 2013 I Written By

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

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.

If you’re in Chicago …

I will be a guest on WGN Radio AM 720 in Chicago at approximately 12:10 p.m. CDT. today, shortly after President Obama’s speech to the American Medical Association concludes.

June 15, 2009 I Written By

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

Breaking news: Private-sector health groups agree to work with Obama

There’s some fairly significant news coming out of Washington tonight: A CNN Money report via Yahoo! says that six key private-sector health industry groups have agreed to participate in the Obama administration’s effort to reform healthcare by pledging to take $2 trillion in costs out of the system over the next 10 years.

“Six trade associations representing unions, hospitals, insurers and the drug industry have signed on to the commitment,” the story says. An Associated Press story says doctors are participating as well. Based on these stories, we can safely assume that coalition includes the AMA, AHA, AHIP, PhRMA and probably the Blue Cross and Blue Shield Association and the Service Employees International Union.

We’ll know for sure Monday when representatives from the six participating groups join President Obama at a press conference.

CNN reports that Obama will make reference to the AHIP-backed ad campaign that torpedoed reform efforts during the Clinton administration. “It is a recognition that the fictional television couple, Harry and Louise, who became the iconic faces of those who opposed health care reform in the ’90s, desperately need health care reform in 2009. And so does America,” Obama reportedly will say Monday.

May 10, 2009 I Written By

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

Sebelius and … who?

While nominating Kansas Gov. Kathleen Sebelius to be secretary of Health and Human Services, President Obama today also picked Nancy-Ann Min DeParle as “health czar,” officially known as the head of the new White House Office for Health Reform.

DeParle’s name is new to me, but I guess it shouldn’t be. She ran the Health Care Finance Administration—now the Centers for Medicare and Medicaid Services—during Bill Clinton’s second term as president and was director of the Office of Management and Budget during Clinton’s first term.

DeParle currently is a director of Cerner, Boston Scientific and Medco Health Solutions. She also is a trustee of the Robert Wood Johnson Foundation. Obviously, she’ll have to quit those boards.

She also is a former Medicare Payment Advisory Commission trustee.

Her husband, Jason DeParle, is a senior writer for the New York Times and an author.

As of this writing, her Wikipedia entry calls DeParle a “MILF.” How long until the White House gets wind of that and makes the change?

UPDATE, 12:40 p.m. CST: This change has been made. I knew it wouldn’t take long.

March 2, 2009 I Written By

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

HHS gets seat on National Economic Council

Among a series of executive orders and other presidential documents not announced by the White House is a Feb. 5 order from President Obama adding the secretary of Health and Human Services and four others to the National Economic Council.

Politico reported Tuesday night that the Obama administration failed to tell the press or post on the White House Web site about several actions the new president took in his first few weeks in office. The orders and other notices came to light only through a careful review of the arcane pages of the Federal Register.

A Feb. 5 order that appeared in the Federal Register on Feb. 11 expanded the National Economic Council by five members, adding: the HHS secretary; White House senior advisor Valerie Jarrett; “climate czar” and former EPA Administrator Carol Browner; the White House chief technology officer; and the administrator of the Small Business Administration.

For the record, Obama has nominated Karen Gordon Mills to head the SBA and Vivek Kundra reportedly will be picked for the Office of E-Government and Information Technology. Of course, we do not know who the permanent HHS secretary will be, thanks to Tom Daschle’s little tax problem. Someone out there must be in line to dole out the $19 billion in health IT cash authorized by the American Recovery and Reinvestment Act.

February 17, 2009 I Written By

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

CMS update

Everybody is looking for information about Charlene Frizzera. You can stop. The bottom line is that CMS will not be making a bio available.

CMS spokesperson Peter Ashkenaz informs me that Frizzera’s role as acting administrator is, just that, purely administrative. Until a permanent CMS administrator is in place, Frizzera, the chief operating officer and a career professional, will essentially be “making sure the trains run on time,” according to Ashkenaz.

As seems to be traditional when the incumbent party loses the White House, one of President Obama’s first acts in office was to halt all pending Bush administration regulations for internal review. That means no federal department or agency will be issuing any new rules or finalizing anything in the works until the Obama administration says so, and that won’t happen in CMS until Obama has his choice in place.

Now who is going to head CMS on a permanent basis? Al Kamen wrote last Friday in the Washington Post that quality guru Don Berwick, Robert Berenson of the Urban Institute and current Medicare Payment Advisory Commission Chairman Glenn Hackbarth are under consideration.

CMS had no comment on that rumor.

January 21, 2009 I Written By

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