Here’s a handy chart from the American Telemedicine Association showing the current status of telemedicine legislation in all 50 states plus D.C. Specifically, it shows which states have already mandated private and Medicaid insurance coverage for telemedicine services, as well as which states are considering such a law. (Medicare policy of course is set at the federal level.) This information is current as of this month.
I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.
The newest installment of Health Wonk Review is up, courtesy of David Williams at the Health Business Blog, and my recent post about politicians perpetuating the myth that the U.S. has the “best healthcare in the world” is featured prominently. If you’re looking for anything else even vaguely related to health IT in this edition of HWR, you might be disappointed, but Williams offers a nice sampling of opinions on other topics that arose during the first presidential debate last week as well as a few ideas that could be considered part of overall health reform.
Speaking of health reform and politics, this morning I received a plea to donate money to the Romney campaign from the nutbars over at Docs4PatientCare. As a rule, I do not give money to any political candidates or to PACs because I want to maintain as much objectivity as possible for someone who occasionally calls people “nutbars.” Why do I say this about D4PC? A year and a half ago, I wrote this:
D4PC contacted me last fall with links to a series of videos, including one from group representative Scott Barbour, M.D. According to the original pitch to me, “Utilizing quotes from Dr. Berwick, Dr. Barbour exposed that, ‘He is not interested in better health care. He is only concerned about implementing his socialist agenda.’”
In another video, Docs4PatientCare Vice President Fred Shessel, M.D., said of Berwick, “This is a man who has made a career out of socializing medicine and rationing care for the very young, the very old and the very sick. It is a backdoor power grab. It is dragging our country down the road to socialism and we should resist it.”
I responded to this pitch with a short question: “Berwick isn’t interested in better care? Do you know anything about his work at IHI?” I never got a response. Docs4PatientCare seemingly was trying to hoodwink media that don’t know any better and/or care more about politics than facts.
Today’s pitch, from Michael Koriwchak, M.D., who calls himself the HIT expert of the group, said, “ObamaCare came along with its promise to destroy our health care system.” I would love to know who made that promise, and why anyone thinks we have such a great “system” now. (Prominent Republican Mike Leavitt, HHS secretary in the Bush administration, has often said we do not have a healthcare “system,” but rather a poorly run, inefficient, dangerous healthcare “sector.”)
“Every dollar you give brings us a step closer to victory in November and the opportunity to replace ObamaCare with doctor-driven improvements to our health care system,” Koriwchak adds. Do we really want “doctor-driven” improvements when physicians won’t admit that they make far more mistakes than any advanced nation should tolerate? I want data-driven improvements.
“The voices of physicians who care for patients every day are now heard in Washington. This may be the last opportunity for you to take back control of your health care. Do you want your health care decisions to be made by you and your doctor, or by an indifferent bureaucrat in Washington?” Koriwchak concludes.
With all due respect, that argument has been beaten to death for years. No bureaucrat in Washington is going to be making care decisions any more than a bean counter at a private insurer does. And patients can’t “take back” control of their care because they don’t have much control now as long as defenders of the status quo in the medical establishment won’t let patients see their own health records and act like physicians are infallible.
Koriwchak kills the little credibility he has left by saying he has “participated in conversations” with several members of Congress and includes the nutty Rep. Michele Bachmann (R-Minn.), who famously formed her views against the HPV vaccine based on what some random woman told her after a debate last year during the GOP primary season.
“She told me that her little daughter took that vaccine, that injection, and she suffered from mental retardation thereafter. The mother was crying when she came up to me last night. I didn’t know who she was before the debate. This is the very real concern and people have to draw their own conclusions,” Bachmann said, without offering a shred of scientific evidence. But if you repeat a lie often enough, people start to believe it. Right, Dr. Koriwchak?
I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.
LOS ANGELES—I’m on the west coast now, first for the USC Body Computing Conference here Friday, and then for the annual Health 2.0 conference up in San Francisco Monday and Tuesday.
Friday there was a lot of talk of healthcare reform. One interesting — and plausible — idea I heard for the first time is that the new Medicare policy of denying reimbursements for preventable readmissions within 30 days of discharge for patients with heart attack, heart failure or pneumonia might have an unintended consequence: We’ll start seeing a lot of readmissions on or after Day 31.
The new policy is one of the many aspects of true reform in the Patient Protection and Affordable Care Act beyond the controversial insurance expansion. And there seems to be a loophole that you can be sure a lot of hospitals will seek to exploit. Even if they don’t, it is hard to change patient behavior, so it’s likely many will come back to the hospital for the same condition, even if it’s not within 30 days.
More importantly, I heard some statistics presented by Stanford dermatology resident Michelle Longmire, M.D., about medical errors: 7o percent of all sentinel events in U.S. healthcare facilities — and there were 8,859 such events voluntarily reported to the Joint Commission between 1995 and the first quarter of 2012, meaning that many times more probably occurred —result from breakdowns in communication. Half occur during patient handoffs such as shift changes, specialist consultations and transfers to other wards or facilities, Longmire said.
I am convinced all the buffoonery that took place while my dad was hospitalized prior to his death was due to communication problems, poorly designed work processes and a culture of covering one’s posterior in an error-prone organization.
This happens far too often, yet some politicians who want to repeal “Obamacare” keep trying to convince the ignorant masses that American healthcare is just in need of a few tweaks.
At the Republican National Convention in August, New Jersey Gov. Chris Christie said the following: “”Mitt Romney will tell us the hard truths we need to hear to end the debacle of putting the world’s greatest healthcare system in the hands of federal bureaucrats and putting those bureaucrats between an American citizen and her doctor.” PolitiFact.com generously rated this as “half true.” However, PolitFact itself noted that the World Health Organization rated U.S. healthcare as 37th of 191 countries in terms of “overall performance.” The Organization for Economic Cooperation and Development says we spend more on healthcare as a share of gross domestic product than any of the other 33 OECD countries. If that’s the “world’s greatest,” I’d sure hate to be worst.
Last week, during the first presidential debate, former Massachusetts Gov. Mitt Romney, the very same Gov. Romney who championed near-universal health insurance coverage with an individual mandate in his home state — a plan first hatched by the conservative Heritage Foundation as an alternative to the Clinton healthcare reform proposal in 1993 — said this:
Look, the right course for — for America’s government — we were talking about the role of government — is not to become the economic player picking winners and losers, telling people what kind of health treatment they can receive, taking over the healthcare system that — that has existed in this country for — for a long, long time and has produced the best health records in the world.
Without getting into what the role of government should or should not do, our health records suck, Our record on producing healthier people is not so wonderful, either. So no matter what Romney meant by “best health records in the world,” he was lying.
I couldn’t help thinking he was playing to this crowd:
Now, this cartoon makes it seem like Obamacare is so wonderful. It’s not. As I’ve said before, having insurance does not mean you will get good care. Having “good” insurance that requires very little out-of-pocket for the patient doesn’t guarantee good care, either, nor does being a VIP. Recall the case of James Tyree, who died from a medical error at a prestigious teaching hospital he was on the board of. The late Rep. John Murtha (D-Pa.) suffered a similar fate despite having “Cadillac” insurance coverage.
I’m going to repeat what is fast becoming my mantra: It’s quality, stupid.
UPDATE, Oct.8: Here’s a summary of what actually is in the Affordable Care Act, and when each provision takes effect, courtesy of the Kaiser Family Foundation.
I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.
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:
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.
I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.
I have railed more often than I can count against politicians and the national media for misleading or at least failing to inform the public on what health reform is all about. For me, it was quite refreshing to see an interview in the Washington Post with Sen. Sheldon Whitehouse (D-R.I.), attempting to shed some light on the parts of reform that have nothing to do with insurance.
“The Affordable Care Act is mostly known as an insurance expansion, expected to extend coverage to more than 30 million Americans,” started the post by Sarah Kliff. “But … a big chunk of the law is dedicated something arguably more ambitious: an overhaul of the American business model for medicine. ‘This is a very significant piece of the bill that has received virtually no attention because it’s so non-controversial,’ Sen. Sheldon Whitehouse (D-R.I.) told me in a recent interview.”
On Thursday, Whitehouse released a 52-page document outlining what he sees as the 47 changes the Patient Protection and Affordable Care Act is making to how care is delivered. That doesn’t even count the reforms in the HITECH section of the American Recovery and Reinvestment Act from a year earlier, by the way.
Health IT, of course, is a big part of reform.”The HITECH Act took important steps to restructure financial incentives to shift the pattern of health IT adoption. The HITECH Act’s Medicare and Medicaid incentive payments are encouraging doctors and hospitals to adopt and “meaningfully use” certified
electronic health records,” Whitehouse noted.
Also from that report:
Health information technology (IT) will radically transform the health care industry, and is the essential, underlying framework for health care delivery system reform. The ACA’s payment reforms, pilot projects, and other delivery system reforms are built with the expectation of having IT-enabled providers. In particular, the shift to new models of care, like ACOs, will rely heavily on information exchange and reporting quality outcomes. Indeed, the formation of ACOs is contingent on having providers “online” to transfer information and patient records, and report quality measures.
Whitehouse did discuss ACOs with the Washington Post, but there’s a reason why the interview appears on a page called the WonkBlog. This stuff is too complicated and wonky for the average person.
What isn’t complicated is explaining that throwing more money at a broken system, as the insurance expansion does, will not lower the cost of care. It also isn’t complicated to explain that tens of thousands of Americans needlessly die each year due to medical errors or low-quality care. Yet, more than a few defenders of the ACA have said that the insurance mandate would help guarantee “quality care” for millions.
Wrong!
The insurance expansion guarantees insurance coverage. It does not guarantee quality care. Whoever wins Friday’s Mega Millions drawing wouldn’t necessarily be able to buy quality care, either. Nor would Bill Gates, for that matter. You can’t get quality care unless you’re willing to address the causes of errors and adverse events. Period.
Sen. Whitehouse seems to understand that. I doubt too many other members of Congress do, despite the fact that a former colleague, the late Rep. John Murtha (D-Pa.), who had the “Cadillac” coverage so many people covet, died as a result of a medical error.
I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.
I don’t like to get political on this blog, but I’ve been thinking a lot about how the Newt Gingrich we’ve seen on the campaign trail of late is quite different from the Newt Gingrich who was a tireless advocate for health IT and EHRs from about 2004 to 2009.
Lately, Gingrich has, as primary candidates are wont to do, been pandering toward the more ideologically pure elements of his party, not addressing the center, as will be necessary during a general election. Notably, Gingrich has jumped on the “repeal Obamacare” bandwagon, essentially making the ridiculous argument that America does not need healthcare reform. That’s interesting, because Gingrich, after he left Congress, founded the Center for Health Transformation to push for technology-enabled health system improvement.
Back in 2004, Gingrich joined with strange bedfellow Hillary Clinton to advocate for a national, government-funded strategy to support adoption of health IT. That idea eventually morphed into the HITECH Act section of the 2009 American Recovery and Reinvestment Act, President Obama’s $787 billion stimulus legislation. Gingrich, like most Republicans, opposed the bulk of the stimulus, but he was an ardent supporter of HITECH. Here’s the proof: Read more..
I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.
This is something I reported for the new FierceEMR last week: There’s a bill in the New Jersey legislature that would effectively ban the sale and use of health IT products that don’t carry CCHIT certification.
My story got picked up Friday by iHealthBeat, where it quickly became one of the top five most-viewed stories and No. 1 on the list of most e-mailed.
The story even drew a comment from CCHIT Chairman Mark Leavitt, who linked to a post on the commission’s blog. There, I learned from a commenter that the bill made it out of committee on a unanimous vote. That’s an ominous sign. If states start setting their own EMR rules, we’ll be left with 50 different systems of interoperability, few of which would actually interoperate with other. We will have wasted billions of taxpayer money on more silos.
If some of the paranoia about EMRs that I heard Sunday at the American Medical Association annual meeting really is representative of practicing physicians—and not just the protectionist Medical Establishment—this country is in trouble.
I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.
Say what you like about the tax problems that forced former Senate Majority Leader Tom Daschle to withdraw from consideration for HHS secretary and criticize his policies all you want, but the Washington Times has officially gone too far. In an editorial today, the favorite paper of the lunatic fringe on the far right compares Daschle’s proposals for increasing the efficiency of healthcare through IT to a Nazi program.
“This notion is fully in the spirit of the partisans of efficiency but came from a program instituted in Hitler’s Germany called Aktion T-4. Under this program, elderly people with incurable diseases, young children who were critically disabled, and others who were deemed non-productive, were euthanized. This was the Nazi version of efficiency, a pitiless expulsion of the ‘unproductive’ members of society in the most expeditious way possible,” the Times says.
The article is accompanied by a photo of Adolf Hitler.
There almost was a cogent argument here. “One provision causing increasing concern is the future role of the National Coordinator of Health Information Technology, who will be in charge of collecting and monitoring the health care being provided to every American,” the Times says, before launching into its Coulteresque polemic. There are legitimate concerns about privacy in the health IT portion of the economic stimulus plan.
Yes, I know the far right likes to shock, particularly in this new era of full Democratic control of the federal government, but come on. The fact that the current national coordinator, Dr. Robert Kolodner, is Jewish, makes this extra offensive.
I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.
Earlier today, I posted news about Allscripts-Misys Healthcare Solutions intending to sell its Medication Services division to an unnamed purchaser for an unspecified amount. I’ve since gotten clarification via e-mail from company spokesman Todd Stein:
“The release is earlier than we would normally have liked because we’re required to reveal all material non-public information about the company prior to undertaking a share repurchase program like the one we also announced yesterday. That’s to ensure that shareholders know everything about the company that they need to know in order to make an informed buy-or-sell decision.”
Indeed, Allscripts announced yesterday a $150 million buyback program and related $150 million increase in its credit commitments.
The company also was named in a Bloomberg story today as one of three firms leading the fight over whether to include greater privacy protections than HIPAA currently affords in the $20 billion health IT section of the economic stimulus legislation. Privacy advocates, including Dr. Deborah Peel’s Patient Privacy Rights Foundation and the American Civil Liberties Union, favor the House version. Business groups, including IT vendors, pharmacy benefit managers and the pharmaceutical industry, prefer the Senate version that allows data mining and direct-to-consumer marketing to continue.
For the record, the other companies named as possible major beneficiaries of the legislation are athenahealth and Quality Systems, the publicly traded parent company of NextGen Healthcare Information Systems.
How do I know this story is a Big Deal? Peel and her cohorts have been very active in keeping the media up to date on developments on Capitol Hill the last couple of weeks, knowing that this could be the last chance for another decade or more to change existing healthcare privacy laws and practices.
I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.
According to the National Council for Community Behavioral Healthcare, both the House and Senate versions of the economic stimulus bill exclude mental health providers from the $20 billion in funding for health IT.
“The National Council is deeply concerned about the lack of direct support for persons with addiction disorders and mental illnesses in the stimulus bill, formally known as the American Recovery and Reinvestment Act. In particular, the economic recovery measure contains no new federal investments for the Substance Abuse and Mental Health Services Administration (SAMHSA). In fact, it appears that SAMHSA is the only operating division within the United States Public Health Service that did not receive emergency funding in either the House or Senate version of the stimulus legislation,” National Council President and CEO Linda Rosenberg, MSW, says in a statement e-mailed to reporters today.
“Also, while privacy protections in the Health Information Technology (HIT) for Rconomic and Clinical Health Act have wide support in the addictions and mental health communities, we were dismayed to learn that the vast majority of our nation’s residential, community-based and individual providers of addiction and mental health services are not eligible to receive Medicaid and Medicare financing or direct grant support under this new HIT initiative. Without the additional resources included in the bill, the goal of community behavioral health organizations to help people with mental illnesses and addiction disorders recover and lead productive lives will be compromised. The community organizations will face many barriers to receiving the Medicare and Medicaid incentive payments for the adoption of HIT technology and will likely be excluded from the grant/loan programs, infrastructure funding, and other HIT provisions of the bill,” Rosenberg continues.
“Let us be clear: parity does not stop at private health insurance coverage. Mental health and addiction providers, both those that receive SAMHSA funding and those that do not, are as much a part of America’s healthcare safety net as physicians and hospitals. Indeed, we confront the same economic conditions including a significant spike in average caseloads combined with successive rounds of state budget cuts.
“The National Council urges Congress to include community behavioral health organizations as eligible entities in the economic recovery bill.”
I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.
