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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.

HIMSS12 notes

I’ve just returned home from HIMSS12. As usual, it was a grueling week, made more grueling by the fact that I arrived a day earlier than usual. But I do have to say that this was the least stressful HIMSS I have been to in years.

Maybe it’s because the conference layout within the massive Venetian-Palazzo-Sands Expo complex was surprisingly compact for my purposes, and I didn’t have to do as much walking as normal. Maybe it was because I only set foot on the show floor once, thanks, in part, to the announcement of the Stage 2 “meaningful use” proposed rules on Wednesday, which caused me to cancel one vendor meeting (in the exhibit hall) and cut another one (in the media interview room) short so I could knock out my story for InformationWeek. Or maybe it’s because I spent too much time in the casinos. Let’s go with the first two, OK?

HIMSS12 broke all kinds of records, drawing 37,032 attendees, beating last year’s former record of 31,500 by nearly 18 percent. The final exhibitor count was 1,123, also the most ever. After I tweeted the attendance figure, at least one person thought this rapid growth was an indication that the conference was “jumping the shark”:

jumping the shark? RT @: #HIMSS12 draws record 37,032 attendees, crushing last year's mark of 31,500. http://t.co/Mw1TDYSA #HealthIT
@apearson
Aaron Pearson

I have thought in recent years than HIMSS may be becoming too big for its own good. This time around, I heard mixed reviews.

Personally, like I said, it was less stressful than normal. It’s always good to catch up with old friends, particularly my media colleagues. This year, I also met up with a couple of friends from back home who happen to work for vendors. We kept the fun going all the way back to Chicago, since at least three other health IT reporters and a few others I know were on the same flight as me.

I also have to say I had a wonderful time on a “Meet the Bloggers” panel on Wednesday afternoon, where I joined Healthcare Scene capo John Lynn, fellow Healthcare Scene contributor Jennifer Dennard, Carissa Caramanis O’Brien of Aetna and moderator Brian Ahier for some lively dialogue about social media in health IT. I know that at least one audience member took some video, and I’ll link to that once it’s posted.

Later that evening, I saw nearly every one of the same people at Dell’s Healthcare Think Tank dinner, where I participated in a roundtable discussion about health IT with a bunch of supposed experts. It was streamed live, and I believe the video will be archived. Many of the participants, including myself, tweeted about it, using the hashtag #DoMoreHIT. I really am adamant about the public needing to be explained the difference between health insurance and healthcare.

Speaking about misunderstandings, I am in 100 percent agreement with something Dr. Wendy Sue Swanson, a.k.a. Seattle Mama Doc, said during an engaging presentation Monday at the HIMSS/CHIME CIO Forum. She made the astute observation that there needs to be better distinction between expertise and merely experience when it comes to celebrities being held up as “experts” in healthcare and medicine. Let’s just say that Swanson, as a pediatrician, is no fan of some of the things Jenny McCarthy and Dr. Mehmet Oz have told wide audiences.

There definitely were some people among the 37,000 who were not enamored with the cheerleading at HIMSS. There was talk around the press room that HHS really dropped the ball by not having the meaningful use Stage 2 proposal out a week earlier, before the conference started. In reality, blame the delay on the White House. Every federal rule-making has to be vetted by the bean counters and political operatives in the Office of Management and Budget, and it’s hard to tell how long the OMB review will take once an administrative agency, in this case, HHS, sends the text over.

I admit, I was wrong in expecting the plan to be out earlier, too. Instead, we got the news Wednesday morning and saw the text Thursday morning, forcing thousands of people to scramble to scour the proposed rules.

I know HIMSS had a team at the ready, who dropped everything to read the proposal and get a preliminary analysis out by the end of the day Thursday. Lots of consulting firms did the same. I’ll save some of the commentary I received for another post.

The wireless Internet in the Venetian’s meeting areas was truly terrible. Either that, or I need to replace my aging laptop. I’m thinking both.

I had no trouble getting my e-mail over the Wi-Fi network, but I really couldn’t do anything on the Web unless I was hard-wired to one of the limited number of Ethernet cords in the press room, and those workstations filled up fast. Bandwidth was particularly poor on Thursday, when I presume thousands of people were downloading the Stage 2 PDF. CMS officials said the Federal Register site crashed from the heavy demand, and I’m sure a lot of it came from inside the Venetian and the Sands Expo.

There didn’t seem to be enough attention paid to safety of EHRs, at least according to Dr. Scot Silverstein of the Health Care Renewal blog, who wrote this scathing critique of the sideshow the exhibit hall has become, making Las Vegas perhaps “fitting for people who gamble with people’s lives to make a buck.”

Personally, I thought ONC and CMS took the recent Institute of Medicine report on EHR-related adverse events pretty seriously. Plus, one of the IOM report authors, Dr. David Classen, presented about the study findings at the physician symposium on Monday and again during the main conference.

Mobile may also have gotten a bit of a short shrift, despite the recent launch of mHIMSS and last’s week’s news that HIMSS had taken over the mHealth Summit from the NIH Foundation. The mobile pavilion was relegated to the lower level of the Sands, the area with low ceilings and support pillars every 30 feet or so. (I called that hall “the dungeon.”) I have a feeling you will like Brian Dolan’s commentary in MobiHealthNews next week. I’m still figuring out what I will write for that publication, but I have to say I did hear some positive things about mobile health this week.

I still don’t know what GE and Microsoft are doing with Caradigm, their joint venture in healthcare connectivity and health information exchange that didn’t have a name until a couple of weeks ago. The name and the introductory reception they held Tuesday evening at HIMSS seemed a bit rushed, IMHO. The Web address the venture reserved, www.caradigm.com, currently redirects to a GE page. Other than the fact that Microsoft is shifting its Amalga assets to Caradigm, I’m at a loss.

Popular topics this year were the expected meaningful use and ICD-10, plus the buzzwords of the moment, business analytics and big data. I’d be happy I never hear the word “solution” as a synonym for “product” or “service” again. To me, that represents lazy marketing. Get yourself a thesaurus.

 

February 24, 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.

Do you trust the cloud for EHRs?

Do you trust the cloud for EHRs? That’s the question I ask in my weekly post for EMR and HIPAA. Check it out, and share your opinion.

May 26, 2011 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: SRSsoft CEO Evan Steele

One of the more interesting figures in health IT is Evan Steele, the outspoken CEO of ambulatory EMR vendor SRSsoft. For years, Steele pushed his Montvale, N.J.-based company’s “hybrid” EMR as a product that won’t slow down “high-performance” physicians. After passage of the American Recovery and Reinvestment Act in 2009, Steele openly boasted that his customers—mostly specialists—were prepared not to receive bonuses for “meaningful use,” a program he believes is skewed toward primary care.

Recently though, Steele has shifted his stance. SRSsoft has rebranded “hybrid” EMR as SRS EHR and now is seeking certification so customers can qualify for the federal incentive program. What makes Steele tick and what led to his change of heart? This podcast provides some answers.

I apologize for the audio quality. I was using a new telephone recording device, and clearly don’t have the settings right. I edited this on an airplane, and the recording was tolerable. Just listen with a bunch of background noise and it’ll be fine. :)

Podcast details: Interview with Evan Steele, CEO of SRSsoft. MP3, stereo, 128 kbps, 27.8 MB. Running time 28:22.
0:57
“Hybrid” EMR and physician productivity
1:40
Change in direction for the company with certification
2:15
What has and hasn’t changed with the product itself
3:10
Still targeting “high-performance” physicians
5:25
Why he says SRS EHR won’t slow physicians down
6:40
Documentation options
7:30
Why he believes Stage 1 meaningful use is skewed toward primary care
9:40
Changes in final regulations that focus on specialists
10:35
Why SRS is seeking certification now
13:00
Differences between SRS and other vendors
14:00
Physician confusion about meaningful use
15:40
“Unnatural” elements for specialists in meaningful use
16:30
Innovation being “sapped” from marketplace
17:00
Gamble of the stimulus
18:15
How SRS is innovating within the confines of the new rules
20:00
Expectations for HIMSS11
22:05
What SRS gets out of going to HIMSS
23:30
SRS’ niche among large, enterprise systems vendors
26:20 Message for HIMSS attendees

February 13, 2011 I Written By

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

Can you handle Extormity’s truth?

Just a couple weeks after I launched my own YouTube channel (still sparsely populated), fictional EHR vendor Extormity has done the same. Coincidence?

Here, Extormity senior executive Frederick “The Colonel” Youngblood testifies before a panel investigating EHR implementation practices. Gotta love movie parodies!

Seriously, though, if Extormity is such a profit machine, how come this video isn’t even available in high quality, much less high definition? Even I have an HD camera.

January 20, 2011 I Written By

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

An EMR in ‘Dilbert’

Did you happen to catch Tuesday’s “Dilbert”? Could this be the first documented use of an EMR in a major comic strip?

Dilbert.com

January 11, 2011 I Written By

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

Welcome to my YouTube channel

First came blogging, then podcasting. Now I’m venturing into vodcasting with my very own YouTube channel.

Here’s my first short video, with me cleaning out my filing cabinet and riffing on the evolution of the health IT industry over the last 10 years, focusing on Physician Micro Systems. The company, which dates to 1983, changed its name to Practice Partner and later was bought by McKesson.

The video is in HD, thanks to my new Kodak PlaySport ZX3 camera (no, I didn’t get the purple). I may be a bit hard to hear when not looking at the camera because the microphone is built into the camera. At least there’s not a lot of background noise. I’m learning, and the videos will get better.

So, without further ado, here is my short video.

Now, who wants to teach me how to embed ads in the videos so I can make a little money with it? The blog and the podcasting sure don’t produce much income.

January 4, 2011 I Written By

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

Healthcare can take a lesson from airline fees

Here’s an idea so radically simple, it just might work.

All the new fees airlines have imposed in the last few years seem to be as popular as a trip to the doctor. But healthcare should follow at least one example to make trips to the doctor a bit more palatable–and safer, too. Plus, practices can benefit from greater efficiency if not also a little extra revenue.

When booking a ticket, airlines now charge somewhere in the range of $15-$25 to speak to a live person, either on the phone or at the airport. That’s because they want you to use their automated, online reservation systems. Customers generally don’t mind doing the work because they get to pick the flights, routings, times and prices most suited to their own needs and they enter all their personal data themselves. It’s more accurate and it saves time and money for the airlines. If customers want the added assistance of a real human being, they can pay for the service.

A medical practice should operate the same way. Let patients book appointments online. Let them fill out their medical histories online, too. Link the data they enter to practice systems so appointments go right to the practice management system and patient history goes to the EMR that most physicians will have (right?) by 2015 or so. You save staff time–even some physician time in the case of medical histories–and avoid errors that come from having to interpret patient handwriting and key their information into the system.

Give patients a financial incentive to use these automated options. Some practices already charge administrative fees to handle the paperwork our inefficient health system often requires. Waive those fees for anyone willing to enter data online rather than making an appointment over the phone or filling out the dreaded clipboard while sitting in the waiting room.

If you’re not comfortable charging an administrative fee, consider waiving co-payments for patients choosing the self-service option. Many of those charges go uncollected anyway.

October 27, 2010 I Written By

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

Early edition

Regular readers of my work for FierceMarkets know that the newsletters usually hit your inboxes in the early to mid-afternoon. Today, many of you will get FierceEMR early as part of a little experiment to see when people open the newsletter and click through to stories.

It’s 9:35 a.m. here in Chicago and 10:35 a.m. at Fierce headquarters in Washington, and today’s issue is done. I’m exhausted from a late night and an early morning trying to meet the early deadline. All the stories are up on the FierceEMR site already, awaiting your perusal. Check them out, while I go get another cuppa–and ponder going back to bed.

This will be the last you’ll read of mine from Fierce until Monday, Aug. 30, as I’m taking a week off. Not a vacation, mind you, but a week off just to catch up on things like sleep, housework and sanity, and hopefully start on a long-delayed home improvement project. I can’t guarantee I’ll blog next week, either, but then again, I haven’t exactly been on a regular schedule here in a while. Paying gigs come first. :)

August 19, 2010 I Written By

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

Another health IT reality check, this time with a patient portal

Remember about 16 months ago when I shared the experience of my own internist’s practice struggling to adopt an EMR?

I went back to the doctor this week for a routine checkup and found that some progress had been made. For one thing, my own doctor charted the encounter electronically. And, much to my pleasant surprise, the practice had started up a patient portal. I discuss my experience with the portal in FierceEMR today.

As a side note, a practice manager from, of all places, Guam, recently contacted me about the original blog post, wanting for me to get him in touch with the practice I wrote about because he was considering the same Sage Intergy system. I was happy to oblige, as was the office manager of my physicians’ practice.

August 12, 2010 I Written By

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