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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, 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, hospital/physician practice management and healthcare finance.

Gingrich on EHRs in the 2009 stimulus

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..

January 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.

AMA and EMRs, continued

Last month, I wrote a rather scathing piece on the BNET Healthcare blog about the American Medical Association‘s annual House of Delegates meeting. I wrote another one for FierceEMR. Admittedly, I focused on a handful of fringe ideas, though one of the more audacious ones actually wound up in a resolution that the House of Delegates adopted as AMA policy. For BNET, I wrote:

[A]nother resolution directs the AMA to tell the federal government that the EMR incentive program “should be made compliant with AMA principles by removing penalties for non-compliance and by providing inflation-adjusted funds to cover all costs of implementation and maintenance of EMR systems.”

It’s one thing to ask for more money to cover ongoing expenses. It’s another thing altogether to conclude that the government is not in compliance with the principles of a private organization. Talk about the tail wagging the dog.

In FierceEMR, I wrote:

Delegates also took issue with the Medicare e-prescribing bonus program that passed during the Bush administration and began this year. They said the requirement that physicians write 50 percent of their Medicare Part D prescriptions electronically was too onerous, and recommended that the threshold be lowered to 25 percent.

Not surprisingly, the posts drew several comments and e-mails.

AMA Board Chairman Joseph Heyman, M.D., someone who actually does understand—and use in his own practice—EMRs and information technology, left a detailed response on the BNET post, attempting to clarify the organization’s position on health IT. He’s right in saying that the AMA did come out in strong support of the stimulus. My criticism was about a few delegates who spoke out rather loudly about the stimulus.

Heyman also discusses the AMA’s online tools for physicians to learn about health IT, something I admittedly didn’t mention in my post, though it wasn’t completely relevant to my argument. I did interview Heyman at the meeting, and included some of his comments in a story I did in the July Physician Office Technology Report of Part B News. I’d like to extend an invitation to Heyman to do a podcast with me at some point in the future so we can discuss all of these issues, as well as his own practice’s successful experience with an EMR.

Another, anonymous, commenter suggested that other organizations, like the American Academy of Family Physicians has an agenda that “more closely aligns with the big winners of the last election cycle, and helped buy them a seat at the table.” Yeah, that would explain why some of the more conservative members of the AMA House of Delegates feel shunned. This person also says that “HIT providers”—vendors and consultants—are the real winners from the stimulus. That’s certainly a risk of the massive program.

The comments on the FierceEMR piece were more supportive of my argument. “Smart Doc” said: “To call this organization an anachronistic dinosaur would not give proper credence to how out of touch it is, not only with the public, but with physicians themselves. Like others of their ilk, they’re against government intervention except when it directly subsidizes them.”

I’m not sure if I’d go that far, but I’m certainly on record as saying the AMA really does not represent the interests of all physicians, as the organization claims to.

My favorite exchange, though, came from Jack Smyth, the very pragmatic president and CEO of ambulatory EMR vendor Spring Medical Systems. After the FierceEMR commentary appeared, he e-mailed me to clarify the rules for the Medicare e-prescribing bonus program that took effect this year:

You commented about the 50% rule for getting the eRx bonuses this year and next. In your statement you mentioned that unless a physician prescribes controlled substances, they should be able to qualify.

The way I understand it, if a doctor enters the prescription in the eRx system, it counts. Even if they have to print it out and sign it, because it’s a controlled substance, or even if the pharmacy doesn’t accept eRx and it has to be faxed to the pharmacy. There are several “G” codes that can be added to an office visit or prescription refill that allow the various scenarios to qualify for addition to the numerator of the equation.

I’m very proud of my subsequent response:

Thanks again for writing. I think you’re right about getting credit for entering it into an eRx system, regardless of whether it’s controlled or if the patient simply wants a printout. In that case, I have no idea why the AMA thinks 50% is too high. You’re either entering scripts electronically or you’re not, unless perhaps you’re Dr. House and you’ve stolen Wilson’s prescription pad.

I also asked Smyth for permission to post our exchange. He then responded: “I love your “Wilson’s prescription pad” comment! Yes you can use my email in your blog. I don’t have time to post responses on websites and I don’t like all of the banter (most of it useless) that a comment like this would create. I’ll let you do that.”

Consider it done.

July 6, 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.

Comparative effectiveness research and the political firestorm

At the risk of being accused again of being a “liberal, shit-sucking scumbag,” I want to draw your attention to a column in today’s Washington Post, that bastion of Eastern liberal media elitism.

Business columnist Steven Pearlstein, clearly part of the vast left-wing media conspiracy, gives a thoughtful review of the controversy surrounding the “comparative effectiveness research”—largely enabled by IT—in the proposed economic stimulus bill now heading toward a resolution on Capitol Hill. Sure, he goes after some of the usual suspects, namely the pharmaceutical and medical device industries, but also explains why the proposal will not turn the U.S. into the British National Health Service.

He also portends the tough battle ahead to achieve comprehensive health reform in this country. If you think this legislation is contentious, wait until it’s time to tackle the Medicare payment structure.

February 13, 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.

Daschle = Hitler? The Washington Times thinks so

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.

February 11, 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.

More D.C. smugness

Tuesday on “Countdown With Keith Olbermann”, with guest host David Shuster, typical Washington know-it-all Craig Crawford of CQ Politics said that the proposed economic stimulus bill making its way through Congress needed more things for people to get excited about. Noting that Woody Guthrie wrote a song about the Grand Coulee Dam after FDR championed the construction project, Crawford said, “I don’t see Bruce Springsteen writing any songs about computerized medical records.”

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No, but Dr. Sam and the Managed Care Blues Band have. Don’t you think people ought to be inspired by, say, not dying because of a prevented medical error?

Again, the mainstream media remain fairly clueless.

February 5, 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.

More commentary

Barack Obama doesn’t take office for nearly four more weeks, but already we’re seeing some pushback against his campaign proposal to ask for $50 billion over five years for health IT.

The federal checkbook, er, money-printing machine, has been busy of late. If the Wall Street and Detroit bailouts have shown anything so far, it’s that a billion dollars just ain’t what it used to be. There are some who are making the case that throwing more money at the healthcare problem might not be the wisest move.

Notably, Bill Yasnoff, M.D., Ph.D., had an op-ed published at BusinessWeek Online last Friday, in which he says electronic medical records must be part of any economic stimulus plan Obama introduces in 2009. Yasnoff pushes for his brainchild, the “health record bank” and calls for greater privacy protection than HIPAA currently affords.

The last point is not surprising, considering Yasnoff is allied with privacy guru Deborah Peel, M.D. For her part, Peel, founder of the Patient Privacy Rights Foundation, sent a letter to Congressional leaders this week complaining of the lack of regulation in recent health IT policy as well as accountability problems with the financial industry’s bailout.

Both Yasnoff and Peel suggest that any funding for health IT must include accountability measures and provisions to ensure sustainability.

C. Peter Waegemann, CEO of the Medical Records Institute also argues against simply throwing money at the problem. In an “HIT Status Report”, posted Dec. 9, cautions that nobody has yet proved that EMRs alone can save money.

“Cost savings can be achieved through a restructuring of healthcare, and EMRs may well be tools in the restructuring process, but they should not be perceived as the main tool or goal and we should not have such unrealistic expectations of them,” Waegemann writes. He also contends that recent federal efforts to promote health IT have failed.

Over at The Health Care Blog, Rick Peters, M.D., argues that the health IT industry is similar to the auto industry of the 1970s, and thus not suitable for a government “bailout.”

And from the Department of Negativity at Any Cost, the Cato Institute‘s Michael Cannon has a blog post entitled, “Blocking Obama’s Health Plan Is Key to the GOP’s Survival.” If so, we’re in for several more years of politics as usual.

December 26, 2008 I Written By

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

More on health reform proposals

Here’s some video from the California HealthCare Foundation

In a Sept. 16 event at the Commonwealth Club of California in San Francisco, McCain health policy advisor Daniel Kessler and Obama advisor E. Richard Brown explained and debated their respective candidates’ positions. It should come as no surprise that IT is but a small part of the discussion.


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If you don’t want to watch all 66 minutes of this video, it’s broken into 13 chapters. Click on “Open Tools” in the video window to select.

October 11, 2008 I Written By

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

Did you notice?

Both John McCain and Barack Obama mentioned electronic health records during last night’s presidential debate. Notably, this was the one debate held in a town-hall format, where the candidates ostensibly spoke directly to undecided voters.

October 8, 2008 I Written By

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