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Health Wonk Review: October Surprise edition

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?

October 12, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality fast $5000 loans-cash.net with bad credit, hospital/physician practice management and healthcare finance.

Most ‘sentinel events’ caused by poor communication

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.

 

October 7, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality fast $5000 loans-cash.net with bad credit, hospital/physician practice management and healthcare finance.

Podcast: This time, I’m the interviewee

In a rare turn of events, I’m the one being asked the questions on a podcast by Sivad Business Solutions, which hosts regular audio discussions on a variety of business topics. I give kind of a high-level view of health IT and offer my very strong opinions on patient safety and healthcare reform. There’s an interesting discussion about EHRs being designed to maximize reimbursements rather than assure safety.

Interestingly, we recorded this via Skype. I like the audio quality, if not the nasal quality of my own voice, more than usual that day.

Hopefully the embedded audio works. If not, click here.

September 18, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality fast $5000 loans-cash.net with bad credit, hospital/physician practice management and healthcare finance.

Health Wonk Review: Special SCOTUS edition

To the surprise of nobody, the healthcare blogosphere was busy last week in the wake of the Supreme Court’s decision on the Patient Protection and Affordable Care Act. Because of this, Joe Paduda at Managed Care Matters put together a special edition of Health Wonk Review. In fact, he did a two-parter, and did it in just a couple of days. My post from Friday just barely made the cut, as the second-to-last entry mentioned in Part 2. Paduda had a lot of fun with Part 1, which he put up late Thursday night in the immediate aftermath of the decision.

I would be remiss if I didn’t also link back to the most recent regular edition of Health Wonk Review, also hosted by Paduda. It’s been up since June 22, but I forgot to mention it before. He included my post about the difficult task of informing the public that they have the right to access and correct their own medical records. Sorry  for the oversight, but better late than never. There’s a lot of other good stuff in there about the future of healthcare reform beyond the ACA, so please check it out.

July 5, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality fast $5000 loans-cash.net with bad credit, 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:

[blackbirdpie url=”https://twitter.com/nversel/status/218345950597492738″]

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 fast $5000 loans-cash.net with bad credit, 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 fast $5000 loans-cash.net with bad credit, hospital/physician practice management and healthcare finance.

Sen. Whitehouse, make some more noise, please

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.

March 30, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality fast $5000 loans-cash.net with bad credit, hospital/physician practice management and healthcare finance.

Podcast: HIMSS CEO Steve Lieber previews HIMSS12

I’m about to head to the airport for my flight to Las Vegas and HIMSS12. As has become customary before each year’s HIMSS conference, I sat down with H. Stephen Lieber, CEO of HIMSS, this past week to discuss the state of health IT and what to expect at the big event.

The timing of this interview was interesting. We spoke Wednesday morning at the new HIMSS office in downtown Chicago, one day after CMS Administrator Marilyn Tavenner told a gathering of American Medical Association leaders that federal officials were re-examining the Oct. 1, 2013, deadline for adopting ICD-10 coding, and one day before HHS Secretary Kathleen Sebelius made it official that there would be a delay.

Also one day after this interview, HIMSS announced that it has taken over the mHealth Summit from the Foundation of the National Institutes of Health. While Lieber talked extensively about mobile healthcare, he gave no hint that this news was coming.

Meanwhile, the whole health IT universe had been expecting HHS to release its proposed rules for Stage 2 of “meaningful use” of electronic health records this past week. That didn’t happen. Monday is a federal holiday, so I don’t think we will hear anything until at least Tuesday, which, coincidentally, happens to be the first day of the HIMSS conference. As if we don’t have enough to keep us occupied in the next few days.

The recording is a little fuzzy. I’m not really sure what created the echo and the background noise, since we were in a dedicated interview room, one of the nice features at the new HIMSS digs. Radio interference perhaps? That happened to me a couple years ago in the old HIMSS office on East Ohio Street. Just pretend you’re listening on AM radio or something.

Podcast details: Interview with HIMSS CEO Steve Lieber, February 15, 2012. MP3, stereo, 128 kbps, 31.9 MB, running time 34:51.

1:00 Logistics of HIMSS12 in Las Vegas after the venue change
2:00 Why the Venetian-Palazzo-Sands might work better than the Las Vegas Convention Center
2:55 Why the conference starts on Tuesday this year
3:25 Massive scale of the conference
5:25 Return of Cerner and Meditech and some first-time exhibitors
7:45 mHIMSS and HIT X.0
10:15 Twitter co-founder Biz Stone keynoting and the state of social media in healthcare
12:00 Accountable care and realignment of incentives
14:15 What might be in proposed rule for Stage 2 of meaningful use
17:20 Preview of HIMSS survey of hospital readiness for meaningful use
20:30 ICD-10 readiness
25:00 Greater public awareness of health IT but continuing difficulties in communicating the finer points of healthcare reform
27:50 Mobile healthcare
31:25 The growing importance of clinical analytics

February 18, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality fast $5000 loans-cash.net with bad credit, hospital/physician practice management and healthcare finance.

Podcast: Intel’s Eric Dishman on connected care management

Did you miss Eric Dishman’s keynote address Tuesday at the Medical Group Management Association‘s annual conference in Las Vegas? That’s OK, because I secured a few minutes with Dishman, director of health innovation and policy at Intel, immediately after his talk, and the results are right here.

This podcast, recorded in the somewhat noisy press room at the Las Vegas Convention Center, is a companion piece of sorts to my coverage in MobiHealthNews on Thursday, so I hope you have a chance to check out both.

Podcast details: Intel’s Eric Dishman on connected care management, recorded Oct. 26, 2011, at MGMA annual conference in Las Vegas. MP3, mono, 64 kbps, 5.2 MB. Running time 11:08.

0:30 Virtual care coordination in nontraditional settings
1:05 Overlap/collaboration with Care Innovations joint venture
2:10 Prototype device for monitoring symptoms of Parkinson’s patients
4:00 Home monitoring of “classic” chronic diseases
4:55 Tracking behavioral changes for prevention and early detection
6:05 Realizing the potential of mobile health
6:55 Care coordination and health reform
8:30 ACOs and payment for quality
9:35 Intel’s future providing “strategic blueprints” for healthcare
10:20 How to share ideas with him

October 26, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality fast $5000 loans-cash.net with bad credit, hospital/physician practice management and healthcare finance.

More reasons why CMS needs Berwick

On Jan. 28, Ron Pollack, executive director of the liberal advocacy group Families USA, introduced President Obama at a Families USA event by saying, “Numerous presidents over many decades tried to secure health reform legislation that would move us toward high-quality, affordable healthcare for all Americans. You, Mr. President, actually achieved it.”

The crowd ate it up.

During the contentious debate over health reform in 2009 and 2010, countless lobbyists, pundits and politicians touted “quality healthcare” as a reason to pass the Patient Protection and Affordable Care Act. Some called for the same “Cadillac” health plans that members of Congress provided for themselves. Many opponents of the legislation countered by saying the U.S. already has the “best healthcare in the world.”

The problem was not one of philosophical differences. The problem was a misunderstanding of a basic fact: health insurance is not the same thing as health care.

Still, politicians keep making the same mistake over and over, and the mass media keep giving them a free pass.

Anyone in the healthcare industry knows that the United States does not have the best healthcare in the world. We have the most expensive care in the world. (Another myth often passed off as truth is that more care and more expensive care automatically equals better care.) Having a “Cadillac” health plan won’t assure you better care, either. Just ask the late Rep. John Murtha (D-Pa.), who, as a member of Congress had such a plan, but still likely died as a result of a surgical error last year.

Another such episode occurred last week. James C. Tyree, chairman and CEO of financial services firm Mesirow Financial, died Wednesday at the University of Chicago Medical Center at age 53. Though Tyree had stomach cancer and pneumonia, the official cause of death was an intravascular air embolism, the result of an improperly removed catheter. That’s one of the National Quality Forum’s so-called “never events.”

As the chief executive of a financial firm, Tyree no doubt had the resources and the insurance to get what some people might call “good, quality care.” He also happened to be on the board of the U of C Medical Center, the very same institution that was so proud of being named one of U.S. News and World Report’s best hospitals in America. Yes, even at the “best” hospitals, mistakes happen, and they happen to people with money and connections.

This is yet another reason why CMS needs someone with a long record of quality improvement, even at institutions with supposedly sterling reputations. Someone like Don Berwick.

If you haven’t already, I encourage you to read the defense of Berwick that I wrote last week so you understand why politics is hijacking better healthcare in America.

March 20, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality fast $5000 loans-cash.net with bad credit, hospital/physician practice management and healthcare finance.