Free Healthcare IT Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Get all the latest Health IT updates from Neil Versel for FREE!

Podcast (but not mine): I discuss ACA, HIPAA, consumerism in healthcare

Longtime readers know how I’ve railed against how the mainstream media’s coverage of healthcare reform in general and the Affordable Care Act in particular, notably the fact that Obamacare addresses a lot more than just insurance coverage. I’ve also railed against how hospitals have used HIPAA as an excuse not to give patients copies of their medical records, when, in fact, the privacy rule says the exact opposite, something HHS finally saw need to provide guidance on just this month.

Those of you who have followed me to MedCity News know that I’ve also been covering the Get My Health Data effort since the beginning last summer — and its roots in the HHS decision to water down “patient engagement” requirements in the Meaningful Use EHR incentive program nearly a year ago.

With this in mind, I knew exactly what I was going to talk about when an old college friend, Missouri lawyer and published novelist Dale Wiley, asked me to be one of the first guests on his new podcast, the Dale Wiley Show. We talked for a good half hour, and probably could have gone on for longer, and I am especially grateful he let me talk about multiple system atrophy, the rare disease that took my dad’s life in 2012.

I do have to take Dale to task for picking a photo of me with my face bandaged from my injury at the 2011 HIMSS conference. He told me he picked more for pixel size than for aesthetic quality. Ah, well. I’m probably due for a new professional headshot anyway.

Click here for the iTunes link to the Dale Wiley Show. Music fans will especially like it, as Dale formerly ran an indie record label and knows a lot of people in the business.

January 18, 2016 I Written By

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

About those Obamacare numbers and the ICD-10 delay

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

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

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

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

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

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

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

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

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

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

 

April 2, 2014 I Written By

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

California HealthCare Foundation CEO Smith stepping down

This comes in late on a Friday, though not as late on the West Coast, where it happened: The California HealthCare Foundation announced that founding President and CEO Mark D. Smith, M.D., will be leaving the influential organization later this year. Over the years, Smith has been a vocal advocate for quality improvement via, among other things, health IT.

I’ve had the pleasure of hearing Smith speak and interviewing him several times over the years, notably at the 2009 American Medical Informatics Association conference and at the 2011 Health 2.0 conference. (Coincidentally or not, both took place at the San Francisco Hilton.) At AMIA 2009, I distinctly remember Smith asking why there wasn’t an Open Table-like service for getting last-minute doctor’s appointments. Not long after that, ZocDoc came along.

Here’s the text of CHCF’s press release:

California HealthCare Foundation President Mark Smith to Step Down

Founding leader of Oakland philanthropy will depart in late 2013

Dr. Mark D. Smith, who has led the California HealthCare Foundation (CHCF) since its founding, plans to step down as president and CEO at the end of year, the foundation announced today.

“It has been a great honor to lead the California HealthCare Foundation in its mission to improve the quality of health care for all Californians,” Smith said. “I leave the foundation knowing it is well positioned to continue this important work.”

During his tenure, Smith focused CHCF on catalyzing efforts to improve health care quality, promote greater access, and reduce the cost of care for the state’s most vulnerable and underserved residents. The Oakland-based philanthropy makes grants totaling approximately $37 million annually from a fund of $700 million. CHCF has granted over $500 million since Smith became the founding president and CEO in 1996.

“Mark Smith’s remarkable leadership over the last 16 years has focused the California HealthCare Foundation on a vision to improve the health care system where it matters most: in the clinics, the hospitals, doctors’ offices, and wherever Californians go to find care,” said Ian Morrison, PhD, chair of the CHCF Board of Directors. “While he recognized that the problems in health care are huge, Mark and his team were smart and innovative in targeting the foundation’s resources where they could most make a difference.”

Smith, 61, a physician and expert on state and national health policy, will continue his work as a member of the clinical faculty at the University of California, San Francisco, and as an attending physician at the Positive Health Program for AIDS care at San Francisco General Hospital, where he has practiced since 1992, including during his tenure at CHCF.

Under Smith’s leadership, CHCF focused on improving the way health care is delivered and financed in California through a number of initiatives, including:

Promoting research and policy analysis. From its founding, CHCF has supported sound decisionmaking using evidenced-based research and nonpartisan policy analysis. CHCF has become a prolific publisher on issues of quality, access, and the financing of care covering both the commercial and public sectors.

Promoting transparency. The foundation has made significant investments in supporting transparency in health care delivery through publicly reporting quality data on hospitals, nursing homes, and long term care facilities, and building public websites that allow consumers to compare local facilities and provide health care leaders with benchmarks for improvement.

Improving clinical care. Smith focused attention on innovative ways to improve care delivery, including being an early proponent of using information technology at the point of care, challenging providers to deliver high-quality and cost-effective care, and promoting disruptive innovations like retail clinics and process redesign. He has also championed redefining the scope of work among clinical team members, to help ameliorate the need to train more doctors to do work that lower-cost members of the clinical team can deliver safely and effectively.

Training new leaders. The foundation initiated the CHCF Health Care Leadership Program at UC San Francisco in 2001. The two-year, part-time fellowship has trained 355 clinicians in management and leadership skills required to lead the state’s health care institutions in a rapidly changing and challenging environment. The program’s alumni now occupy leading positions in hospitals, clinics, medical groups, and government throughout the state.

Fostering innovation. The $10 million CHCF Health Innovation Fund helps accelerate innovation in care delivery by investing in new and emerging companies focused on lowering costs and improving access to care. While supporting improvements to the health delivery system, CHCF also has focused on the rise of alternative care delivery models such as retail clinics and the adoption and effective use of information technology.

Modernizing enrollment. CHCF has been a leader in promoting more efficient and consumer-friendly ways for eligible Californians to enroll in public programs. In 1999 the foundation supported the development of the first web-based eligibility and enrollment application in the United States, which it licensed at no cost to the State of California. More recently CHCF led the successful national public-private development of a first-class user experience design to streamline enrollment under the Affordable Care Act (ACA). The foundation has also recently focused on supporting the implementation of the ACA in California, and continues to monitor and report on its progress.

Supporting health care reporting. Recognizing the important role that the media has in promoting improvements in health care, CHCF has devoted significant resources to supporting health care journalism. Since 1998, the foundation has produced California Healthline, a daily digest of news, analysis, and opinion on the state’s health care system. In 2009, the foundation established the CHCF Center for Health Reporting at the USC Annenberg School of Communication and Journalism, which collaborates with media across the state on in-depth, explanatory journalism on critical health care issues.

“Mark has built a strong staff that is set on a steady course, focusing on the medical delivery and financing systems in California, with an emphasis on quality improvement, increasing both access and efficiency, and addressing the unsustainable cost of care to individuals and society,” Morrison said. “The board expects the foundation to continue building on its successes in these areas.”

“There is still a lot of work to be done. While I will assist the board and staff in making a smooth transition to a new leader, I will also continue to look for ways to make our health care system work better for the people of California,” Smith said.

A native of New York City, Smith earned his bachelor’s degree in Afro-American studies at Harvard (1979), his medical doctorate from the University of North Carolina at Chapel Hill (1983), and a master’s in business administration with a concentration in health care administration from the Wharton School at the University of Pennsylvania (1989).

Prior to joining CHCF, Smith was executive vice president at the Henry J. Kaiser Family Foundation. He previously served as associate director of the AIDS Service and assistant professor of medicine and of health policy and management at Johns Hopkins University. He has served on the board of the National Business Group on Health, the performance measurement committee of the National Committee for Quality Assurance, and the editorial board of the Annals of Internal Medicine.

He was elected to the Institute of Medicine (IOM) of the National Academy of Sciences in 2001 and recently completed service as the chair of an IOM committee on “The Learning Health Care System in America,” which issued its report Best Care at Lower Cost in September 2012.

Smith will continue serving as CHCF’s president and CEO until a new leader is in place, which is expected by the end of 2013. The search for Smith’s successor will be conducted by the foundation’s board of directors. Inquiries should be directed to Carol Emmott of Russell Reynolds Associates at cemmott@russellreynolds.com or 415-352-3363.

About the California HealthCare Foundation

The California HealthCare Foundation works as a catalyst to fulfill the promise of better health care for all Californians. We support ideas and innovations that improve quality, increase efficiency, and lower the costs of care.

 

CHCF also released a statement from Board Chair Ian Morrison, Ph.D.:

The Philanthropic Leadership of Dr. Mark D. Smith

Ian Morrison, PhD, MA, Chair of the CHCF Board of Directors

The CHCF board of directors conveys its pride in what has been achieved under Dr. Mark Smith’s extraordinarily creative leadership and reinforces its commitment to the strategy, programs, and initiatives that CHCF has spearheaded over the last 16 years.

 

January 11, 2013

The board of directors of the California HealthCare Foundation has asked me to communicate our pride in what has been achieved under Dr. Mark Smith’s extraordinarily creative leadership and to reinforce our commitment to the strategy, programs, and initiatives that CHCF has spearheaded over the last 16 years.

We recognize and anticipate that our next leader will bring fresh ideas and energy that will take us in new directions. We are also firm in our belief that the California HealthCare Foundation will continue to play a central role at the intersection of the health care delivery system and the policy world that Dr. Smith carved out during his tenure.

We take great pride in the fact that CHCF is a respected resource for objective research, information, data, and analysis on a broad range of health care issues in California; a trusted convener; and a creative helping hand, spurring on innovation in the market and the policy community to benefit the health of all Californians. In reflecting on Dr. Smith’s extraordinary leadership, the board has identified 10 areas where the foundation has had particular impact.

All of these efforts have been shepherded by the foundation’s most powerful asset: its staff. Each board member will attest to the quality of people who work for CHCF: their energy, enthusiasm, expertise, and professionalism are truly impressive.

The consistently high standards of the foundation’s staff, grantees, and partners have resulted in a remarkable body of work that has made important contributions to improving quality, access, and affordability of health care services in California and the nation. This list samples from the many and various ways CHCF has made a difference. Dr. Smith’s leadership signature is evident in all of them and together they reflect the enduring DNA of this organization that we believe will carry on under his successor.

1. The Fruits of Conversion: The Orderly Creation of Two Important Philanthropic Foundations

CHCF was originally tasked with managing the sale of Wellpoint stock following the conversion of Blue Cross of California to for-profit status and transferring 80% of the proceeds to The California Endowment (TCE), our sister foundation. The founding CHCF board and staff under Dr. Smith’s leadership managed the process smoothly and created the endowment for TCE, which today has assets of $3.2 billion and annual giving in excess of $165 million. CHCF’s 20% of the proceeds amounted to almost half a billion dollars at the time, and Dr. Smith led the process of developing a complementary strategy and grants program. The result was the creation of two important health care philanthropies in the state: The California Endowment, which focuses on community-level initiatives to improve access and public health, and the California HealthCare Foundation, which focuses on policy and practice change in health care financing and delivery.

2. A Market Savvy, Policy-Relevant, Innovative, and Trusted Philanthropy

We are proud of our position as a trusted convener of health care stakeholders from the worlds of policy and industry. We value our reputation as an organization that simultaneously understands market dynamics and the intricacies of policy at federal, state, and local levels. Dr. Smith and the staff have built the capacity to navigate through this difficult terrain, but most importantly, to identify creative ways to intervene and play a catalytic role. Our board has strongly supported the identification of unique points of leverage on market-makers and policymakers alike to help improve quality, access, and affordability of health care for all Californians.

3. Support for New Leaders

Early in CHCF’s history, in collaboration with the University of California, San Francisco, CHCF conceived of a professional development program for clinical leaders in the state, particularly those serving in safety-net institutions. The purpose was to provide young clinicians with the leadership skills they would need to head their organizations in the future. The program currently has 355 alumni across the state and the board recently announced the foundation’s support for two new classes. The program has been emulated by other foundations and institutions in California, resulting in a total of more than 2,000 graduates across the state. Any meeting of California health care leaders is likely to include graduates of these programs, and many of them have become important grantees, partners, and champions for constructive change across California’s health care system.

4. The Adoption and Effective Use of Health IT

CHCF has always been known as a pioneer in the promotion of health information technology as an important tool to improve the quality, safety, and efficiency of care delivery. Some may point to our investments in the creation of the Santa Barbara County Care Data Exchange as taking a large risk (as we explored in a self-reflective 2007 Health Affairs special section). But as a board, we have been consistent in our support for investment and improvement in the use of new information technology in health care. And indeed we firmly believe that Santa Barbara was a catalyst for the significant federal HITECH investment that has followed.

While CHCF has had a long and important interest in promoting health IT to improve clinical care, we have also made special contributions in the seemingly arcane area of enrollment modernization. Building on Mark Smith’s and Vice President of Programs Sam Karp’s combined belief, interest, and expertise in the area, CHCF created important tools, technologies, and policy processes to help automate and modernize enrollment in public programs such as Medi-Cal and Healthy Families. Health-e-App and One-e-App not only enabled thousands of Californians to secure the coverage they were eligible for, but these pioneering efforts laid critical groundwork and built expertise in online enrollment and user experience design that has informed policy and practice related to implementing the Affordable Care Act in California and nationally.

5. Technical Assistance for the Safety Net

Much of CHCF’s work has involved deep engagement with public hospitals, community health centers, and county-organized health systems to improve quality, access, and affordability, particularly for patients with chronic conditions. Through a wide range of projects and initiatives, CHCF has supported chronic disease registries, electronic health records, telehealth adoption, quality improvement activities, and measuring and improving patient experience in institutions that lack the resources, capacity, or time to invest in delivery system transformation. These programs have helped improve access to care for specialty services for the underserved and the quality of care for patients with chronic illness, as well as improve the efficiency, service level, and throughput of overstretched safety-net providers.

6. The California Health Care Almanac and Information Services

CHCF plays an active role in monitoring the functioning and improving the transparency of health care policy and practice in California. Through a wide range of sponsored studies, custom reports, and news services under the broad rubric of the California Health Care Almanac, California Healthline, and iHealthBeat, the foundation keeps health care leaders informed about what is happening, what is important, and what lies ahead. The consistent quality and timeliness of this work has created a resource base that is relied upon by managers, policymakers, consultants, and academics, in the state and across the country.

7. CHCF Center for Health Reporting

CHCF recognized with concern that the ongoing transformation in media was undermining the economic viability of quality journalism in the health care field. The foundation created the CHCF Center for Health Reporting at the USC Annenberg School for Communication and Journalism to support high-quality reporting in partnership with media outlets in the state. The results can be seen in the number of stories produced in state and local media and their impact on the policy discourse on important topics, including the performance of Denti-Cal plans, the public conversation on end-of-life issues, and variation in the quality of care delivered across the state.

8. CHCF Health Innovation Fund

CHCF has committed $10 million over three years to invest in new ventures that have the potential to reduce the cost of care or improve access for the neediest Californians. The fund is off to an exciting start with several important investments in promising start-ups that we hope will create lasting value and improvement in health care delivery in areas such as telehealth access to specialists, better asthma management, and more efficient pharmacy services for rural and safety-net institutions. The fund is at an early stage, but we are excited by the prospects for this program-related investment (PRI) vehicle to innovate in areas of greatest need that the market might have overlooked without our help.

9. End-of-Life Care

End-of-life care has become a focus of the foundation because of the wide gap between the way Californians say they want to spend their last days and the highly medicalized way that many of them die. The foundation has supported greater clarity in end-of-life wishes through use of POLST (Physician Orders for Life Sustaining Treatment) forms across the state. Major progress has been made in making this a standard of care. Similarly, CHCF grants and initiatives have enabled every public hospital in the state to establish palliative care programs over the last five years. CHCF remains committed to raising awareness of Californians’ wishes for the care they receive at the end of life and in supporting care choices that are consistent with those wishes.

10. Supporting Improvement in the Medi-Cal Program and the Implementation of the ACA

CHCF has joined with other foundations and has worked with policymakers and state agencies and departments to provide instrumental technical support for many dimensions of the Medi-Cal program and the implementation of the Affordable Care Act, including:

  • Informing the development of enabling legislation for the state-based health benefits exchange
  • Providing technical support on the development of Medi-Cal waivers
  • Developing performance standards for Medi-Cal beneficiaries with disabilities and monitoring and evaluating their transition into Medi-Cal managed care
  • Informing California’s implementation of coverage expansion and insurance market reform, health IT deployment, and quality improvement initiatives

This important work continues.

Over the course of the next year, there will be many opportunities to toast Mark Smith’s legacy and contributions, and also time to warmly welcome a new leader. As we embark on this journey, the CHCF board of directors is proud of CHCF’s past and confident in its future. With the board’s strong encouragement and support, Mark Smith and his team have created an important institution that will continue to serve Californians in the decades ahead, building on a rich legacy of creativity and innovation, as evidenced in these efforts we highlight today.

January 11, 2013 I Written By

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

Berwick, after the fact

The tragedy of Dr. Don Berwick’s short tenure as head of the Centers for Medicare and Medicaid Services has been well-documented, including right here on this blog. Berwick got in by a controversial recess appointment because President Obama didn’t have the political courage to fight for his nominee and allow Berwick to face the Democratic-controlled Senate. Berwick, of course, quit late last year when it became clear Obama would not renominate Berwick for the job he is uniquely qualified for.

There have been a number of postmortems in the press, where Berwick discussed his experience running CMS, including the challenges of implementing both the HITECH Act and the Patient Protection and Affordable Care Act and his. continuing efforts to improve the quality of care in this country. But I haven’t seen one quite as good as what Dan Rather just produced.

The former CBS News anchor has been toiling in relative obscurity at HDNet, a hard-to-find cable network run by billionaire Mark Cuban. Fortunately, Rather took to the far more popular Huffington Post this week to share his thoughts on a recent interview he conducted with Berwick.

“Dr. Don Berwick, a pediatrician by training, came to Washington with a sterling reputation among people who actually know something about health care. He had helped pioneer the Institute for Healthcare Improvement, which may sound like another pointy-headed D.C. think tank, but really is a Cambridge, Massachusetts-based organization lauded the world over for helping make health care systems better. For example, they have worked with hospitals on common sense techniques to reduce hospital infections. These are serious people who are welcomed in hospitals and clinics across the country and around the world,” Rather wrote on HuffPo.

That’s right, Rather understood Berwick’s background, unlike, say Dr. Scott Barbour of a crackpot group called  Docs4PatientCare. “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,’” read a pitch I received from that organization last year.

I’ve been over this before. Berwick has probably done more to improve the quality of care and save lives than anybody else on the planet today. Some of the people who publicly opposed his nomination privately knew this, as Rather’s interview with Berwick demonstrates:


Yes, most of the opposition was an elaborate lie perpetrated for political gain. In today’s Washington, is anybody surprised? The losers once again are the American people and anybody who comes to this country for healthcare.

February 16, 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.

Reactions to final ACO rule

As you probably heard, CMS today released a 696-page final rule on accountable care organizations. I wrote a piece for InformationWeek Healthcare that should be posted no later than tomorrow morning, so I’m not going to rehash that. What I will do is show you the various reactions from many interest groups to the rule, particularly the ones that have an IT bent. Unfortunately, there haven’t been too many released so far, and none from the major health IT associations. Now, AMIA and CHIME are gearing up for their annual conferences next week and, let’s face it, the rule is 696 pages long, so I’ll update this page as statements come in.

For the official line, see CMS Admnistrator Don Berwick’s commentary in the New England Journal of Medicine. Notably, he mentions EHRs in the very first paragraph, in which he explains how he delivered accountable care as a Harvard pediatrician.

From the private sector, the American Hospital Association liked the flexibility in the final rule, as evidenced by this statement:

STATEMENT ON FINAL ACO RULE

Rich Umbdenstock
President and CEO
American Hospital Association
October 20, 2011

Today’s rules represent the direction in which the hospital field is moving – toward better coordinated patient care across care settings. We commend CMS for listening to the concerns of America’s hospitals. The hospital field is actively working on ways to improve care delivery and the final accountable care organization rule provides hospitals a better path to do so.

In response to the concerns of the AHA and its hospital members, CMS made significant changes to the financial model, provided more flexibility in the assignment of beneficiaries and took a second look at the quality framework. We believe today’s menu of ACO options allows America’s hospitals to create new models of accountable care organizations on which the transformation of health care delivery is so dependent.

The AHA is also encouraged by the historic effort among several federal agencies to achieve the goal of better coordinated care. Specifically the antitrust agencies responded to hospital concerns and reversed their plan to require antitrust preapproval for every ACO applicant and instead provided guidance. We believe removing this barrier was essential to encouraging ACO participation.

Hospital and health system leaders welcome the concept of providing patient care in a more accountable, more coordinated way and know that they will be held increasingly at financial risk in improving outcomes for patients and becoming more efficient in the delivery of services. Hospitals already are engaged in private sector ACO initiatives and the final rule provides an additional avenue for the provision of accountable care.

The AHA strongly supports the goals and principles of the ACO program and delivery system reforms that improve patient care and quality while reducing costs. We will continue to work with CMS and other agencies to remove the substantial legal and regulatory barriers throughout the health care system to clinical integration that still remain.

I understand the American Medical Association had similar impressions, but I haven’t actually seen the AMA’s statement yet. However, the Advanced Medical Technology Association (AdvaMed), which stands to lose if expensive diagnostic tests are reduced, was disappointed:

AdvaMed Statement on

Final Accountable Care Organization Regulation

WASHINGTON , D.C. Ann-Marie Lynch, executive vice president of the Advanced Medical Technology Association (AdvaMed), released the following statement regarding the Centers for Medicare and Medicaid Services (CMS) final rule on Accountable Care Organizations (ACOs):

“AdvaMed is concerned that CMS failed to address key issues in the final ACO rule that would have advanced patient care, ensured patient access to innovative treatments and technologies, and avoided incentives to stint on care.

“We are also concerned the rule does not address the very real danger of slowing the development of new treatments and cures. The failure to consider how innovative products play an important role in improving patient care threatens medical progress for current and future patients. Without certain design elements, the ACO program may have the effect of limiting treatment options and discouraging physicians from adopting new advancements in care.

“CMS failed to include or even discuss common-sense provisions to support continued medical progress, despite concerns expressed by the life science industry, patient groups, and members of Congress. CMS’ action runs counter to the President’s January 18 Executive Order directing agencies issuing regulations to seek to identify ways to promote innovation and undercuts the President’s goal of fostering a ‘national bioeconomy.’

“We are also disappointed that CMS rolled back rather than revamped the quality measures included in the draft rule. The final rule lacks sufficient measures of patient outcomes to assure quality of care. There are large areas of clinical practice not addressed at all – including cancer, severe arthritis, chronic pain and osteoporosis.

“This rule is a missed opportunity to ensure that the sweeping changes in payment policy established by the Affordable Care Act will support medical progress and assure that patients can receive the care most appropriate for their needs.”

The Association of American Medical Colleges was thrilled that med schools won’t be held to the same standards as everyone else:

AAMC Applauds Final ACO Rule Excluding Medical Education Payments

Washington, October 20, 2011AAMC (Association of American Medical Colleges) President and CEO Darrell G. Kirch, M.D., issued the following statement today on the Medicare Shared Savings Program “Accountable Care Organizations”(ACO) Final Rule:

“The AAMC is pleased that the ACO final rule excludes indirect medical education payments from the methodology used to assess shared savings under the program.  By not including these policy payments in the historical cost analysis, medical schools and teaching hospitals— institutions that often treat the sickest and most vulnerable patients—have a better opportunity to participate in the ACO initiative.

While we are still examining the details of the final rule, the AAMC has always been supportive of new models of care that put patients first and also leverage the benefits of institutions’ educational and research missions to reign in the unsustainable growth in health care costs.  We look forward to working with our members, the Center for Medicare and Medicaid Innovation, and the Centers for Medicare and Medicaid Services to help identify ways to partner with the academic medicine community and institutions working to advance meaningful health system innovation.”

The Campaign for Better Care, a coalition of consumer groups interested in quality care for seniors, called the rule a “reasonable compromise”:

Consumer Groups Say New Accountable Care Organization Rule is a  Reasonable Compromise, Urge All Parties to Get On-Board to Ensure Patients Will Soon Benefit from Better Coordinated,  More Patient-Centered Care

Statement of Campaign for Better Care Leader Debra L. Ness

“The final rule on Accountable Care Organizations (ACOs), released by the U.S. Department of Health and Human Services today, has provisions that will both please and concern various parties.  As advocates for consumers, particularly for our oldest and sickest patients who urgently need better-coordinated care, we applaud this effort to incentivize better primary care, increase coordination, and share accountability across providers.  We are very pleased that this final rule will require ACOs to adhere to strong patient-centered criteria, use beneficiary experience of care measures to evaluate performance, and ensure full transparency, notification and choice for beneficiaries.  These provisions are all essential to realizing the promise of successful ACOs, which patients in this country are counting on.

This new rule is not perfect, but it provides a path away from the broken, dysfunctional health care system we have today toward a system that offers higher quality, better coordinated and more patient-centered care.

We consider it most unfortunate that the provisions requiring beneficiary participation on ACO boards have been tempered.  We urge the Department to closely monitor these provisions to ensure that consumers and beneficiaries are engaged in the design, governance and assessment of ACOs in their communities.  We will be watching closely to assess whether ACOs operate in the public interest and reflect the needs and perspectives of the communities they serve.  Consumers and patients hope and expect that these provisions will be strengthened down the road if needed.

In the end, we see this rule as a reasonable compromise.  The Department was enormously responsive to the comments that were filed and in particular, to concerns raised by providers.  It is time now for all parties to come together to create successful ACOs that deliver care that is truly patient-centered, that improves quality and care coordination, and that lowers costs.  This new model of care deserves to be tested along with the numerous other innovations that have and will be promoted by the CMS Innovation Center.  Patients and consumers have no time to waste.

The stakes are too high to ignore the promise that ACOs offer to improve care and bring us better value for our health care dollars.  We must not let opponents of reform use any remaining differences to block the progress Americans so urgently need.  Transformation is never easy, but the cost of failure to patients, families and the country is simply too high.”

AARP called the rule a “good first step” in improving quality and lowering Medicare costs:

AARP Statement on New HHS Programs Designed to Improve Coordination and Quality of Patient Care in Medicare

WASHINGTON—AARP Legislative Policy Director David Certner released a statement following today’s announcement that the Department of Health and Human Services (HHS) has issued a final rule introducing two new programs—the Medicare Shared Savings Program and the Advance Payment model—to help providers better coordinate patient care and use health care dollars more wisely through accountable care organizations (ACOs). Both programs create incentives for health care providers to work together to treat an individual patient across care settings – including doctors’ offices, hospitals, and long-term care facilities. Certner’s statement follows:

“Accountable care organizations have the potential to improve the quality and lower the cost of health care for all patients. By working across the spectrum of providers to ensure that patients get the right care at the right time and in the right setting, accountable care organizations have shown great promise in positively changing the way we deliver care.

“The programs announced today can benefit people in Medicare by encouraging providers to work together to better coordinate patient care, which can lead to fewer hospital readmissions and lower Medicare costs. AARP believes today’s announcement is a good first step and we welcome the chance to further review these programs.”

 

October 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.

Berwick political saga is a tragic attack on better healthcare

President Barack Obama has made plenty of mistakes in his first two-plus years in office, but none may be more serious for the future of America than his decision to install Donald M. Berwick, M.D., as a recess appointment to head the Centers for Medicare and Medicaid Services in July 2010.

Berwick really is a great choice to head CMS, but the underhanded nature of the recess appointment has provided fodder for all kinds of uninformed ideologues and assorted nut jobs to attack Obama’s healthcare reform efforts. Just as CMS is gearing up to release widely anticipated proposed regulations for Accountable Care Organizations, we get the sad news that that Berwick’s days are numbered.

After refusing to allow Berwick to testify before the Senate last year, Obama renominated Berwick on Jan. 26. Newly empowered Republicans went on the attack. “The White House’s handling of this nomination—failing to respond to repeated requests for information and circumventing the Senate through a recess appointment—has made Dr. Berwick’s confirmation next to impossible,” the widely respected Sen. Orrin Hatch (R-Utah) said, according to American Medical News.

On March 4, Politico reported that Senate Democrats had given up on the nomination, despite the fact that Berwick had the support of the Medical Group Management Association, the American Hospital Association, the American Public Health Association and, notably, the Republican-leaning American Medical Association and America’s Health Insurance Plans.

How did this happen?

As I wrote last November when Republicans proposed de-funding of the Center for Medicare and Medicaid Innovation, a key element of real reform in the widely misunderstood “healthcare reform” legislation (the main misunderstanding is that insurance is not the same thing as care):

The Patient Protection and Affordable Care Act, widely referred to as “healthcare reform” and mocked by some as a government takeover of healthcare, aka “ObamaCare,” is not popular in Republican circles. That’s no secret.

It’s also well known that, in their drive to repudiate everything Obama, many Republicans, giddy over their victory in last week’s midterm election, have said they want to repeal the PPACA in its entirety, throwing out the baby with the bathwater. (You know, our healthcare system is wonderful the way it is, so we didn’t need any changes in the first place.)

What really got me was the news that some of the more conservative and libertarian elements of the GOP are specifically threatening to pull the $10 billion in funding already authorized for the Center for Medicare and Medicaid Innovation, a CMS program created by the PPACA. This is a center that CMS Administrator Dr. Donald Berwick has called “the jewel in the crown” of the reform bill, and Berwick has unfairly been labeled a socialist, granny-killing pariah by some right-wing zealots who have no idea of his life-saving work at the Institute for Healthcare Improvement.

The new Republican-majority House of Representatives could not make a bigger mistake than defunding the Center for Health Innovation. For years, conservatives have complained of Medicare’s plodding bureaucracy impeding innovation—you know, the very thing the program is intended to foster.

What the PPACA does is allow CMS, via this new innovation center, to try new ideas without having to make sure their experiments are budget-neutral from the start. (The requirement for budget neutrality is why Medicare pay-for-performance and pay-for-prevention initiatives have never really gotten off the ground.) And CMS no longer has to be content with small demonstrations. Instead, the Center for Medicare Innovation is authorized to run wider-scale pilots and then seek congressional appropriations to ramp up any program that proves successful in producing better care for less money.

That’s how you bend the cost curve, a favorite term in policy circles. Killing the Center for Medicare and Medicaid Innovation would just perpetuate the ugly status quo.

That commentary drew five responses on the site, four of which were negative. And every last one of the negative comments were written anonymously. The only commenter to list a name also happened to be the lone supportive response.

I am in no way surprised. Politically motivated lies abound about Berwick, and few of the critics want to be held accountable for misleading the public.

The week before last, I was somewhat critical of the Lucidicus Project and Jared M. Rhoads, who hosted the most recent Health Wonk Review. He did a fine job hosting HWR, but in scanning some earlier posts on the Lucidicus site—hewing closely to confused, angry, misguided ideology of the tea party—I noticed something that got my blood boiling.

On Jan. 27, Rhoads wrote that Berwick was “on a one-way path,” a path that leads to socialism and a government takeover of healthcare. “Without free-market solutions on the table, the one-way march to an NHS-like system will continue. Berwick has just one solution in mind for the problems created by government: more government.”

He also wrote, “Berwick is openly enamored of the U.K.’s National Health Service (NHS) model, in which the government essentially makes decisions for people about the care that they receive, and in which patients can be penalized for attempting to pay for additional care out of their own pockets. The system is characterized by bureaucracy, rationing, and redistribution of wealth and resources.”

At least give Rhoads credit for not cowardly hiding behind a cloak of anonymity.

Yes, it is true that Berwick has publicly spoken of his admiration for the NHS, but it was more about the British decision to make quality improvement a key element of healthcare than it was about a desire to bring an entirely government-run system to the United States. In my post about that edition of HWR, I asked if Berwick hadn’t done more to prevent needless deaths and adverse events than pretty much anyone else alive today.

That’s the same question I asked in an e-mail to the anti-reform (read “crackpot”) group called Docs4PatientCare. Why do I say crackpot? The Atlanta-based organization 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.

Here are the facts, from another piece I wrote last year:

A longtime champion of patient safety, Berwick co-founded the Institute of Healthcare Improvement in 1989 and led it until he became CMS administrator by virtue of a controversial “recess appointment” in July 2010, preventing the Senate from questioning him about his views. At IHI, Berwick created and championed the 100,000 Lives Campaign, an effort to prevent that many deaths in an 18-month period by getting thousands of U.S. hospitals to follow simple, preventive safety measures voluntarily. The program later turned its focus to nonlethal adverse events and became the 5 Million Lives Campaign. Berwick is a pediatrician who also holds a master’s degree in public policy.

In kicking off the 100,000 Lives Campaign in December 2004, Berwick made the following audacious challenge to American hospitals: “I think we should save 100,000 lives. I think we should do that by June 14, 2006. 9 a.m.” At that appointed hour 18 months later, he announced that the campaign had prevented 122,300 unnecessary deaths. Berwick was careful not to make IT a prerequisite for participating in either campaign, but he’s come to see the benefits of EMRs and clinical decision support. Now, as head of CMS, he effectively leads the “meaningful use” incentive program. Though the Stage 1 rules were mostly done by the time he took the reins, you can be sure Berwick will be pushing for true quality improvement in subsequent stages of meaningful use.

The key word in the above passage is “voluntary.” There were no mandates when the private-sector IHI encouraged hospitals to do what is right for patients.

Months later, Berwick has indeed been pushing for true quality improvement in meaningful use. I’ll have more on that later in the week.

March 14, 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.

A new focus: How to become empowered patients

Attention, kind readers. After years of doing this blog in fits and starts — particularly the two-year gap while I was essentially prohibited by a full-time employer from writing about health IT here or anywhere else but that company’s site — I have decided to refocus on healthcare consumers rather than industry insiders.

The “Meaningful HIT News” name itself has become dated, given that the Meaningful Use program from which this blog takes its name has evolved and kind of fallen out of favor. For those not up on the lingo, “meaningful use” is the standard healthcare providers must meet to qualify for Medicare and Medicaid bonus payments for use of health information technology and/or avoid penalties for not being “meaningful” users of electronic health records.

The program came about in 2009 with the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act, a bipartisan part of the very partisan American Recovery and Reinvestment Act (ARRA); ARRA was President Barack Obama’s $831 billion stimulus legislation. Despite what you may have read elsewhere, Meaningful Use was not part of the Patient Protection and Affordable Care Act, the 2010 bill that’s come to be known as Obamacare.

Meaningful Use was largely successful in getting hospitals and physician practices to adopt electronic health records, which was the goal of Stage 1 (2011-13, give or take). But it started to fall apart in Stage 2 (2014-16), which required participants to share data with other healthcare organizations. Now we have reached Stage 3, in which hospitals and doctors are supposed to prove that they are able to provide better, safer, less costly care with the help of their electronic records.

While all this was happening, Congress got impatient about the $35 billion in incentive money that has been distributed to date and passed legislation at the end of 2015 that changed how physicians are paid for treating Medicare patients. Long story short, Meaningful Use Stage 3, at least for doctors and other individual practitioners, is now part of a bigger calculation that pays for outcomes rather than for simply providing more services. The Meaningful Use program remains unchanged for hospitals.

I won’t bore you with any more details, but I think it’s time to look at the bigger picture, namely the rights and responsibilities patients have in making their own care better. Stay tuned for real patient stories and advice in the next few days. In the meantime, check out the post that represented a shift in my thinking, after my dad passed away nearly five years ago.

I want to help you become empowered patients. That, to me, is what is really meaningful.

I’ll categorize every relevant post as “The Patient Journey” so you can find these stories in the future.

 

March 30, 2017 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 Republicans just say they were fine with ‘death panels’ themselves?

Remember the “death panels” hysteria in 2009 or so when the Affordable Care Act was under development? (PolitiFact called “death panels” the “lie of the year” for 2009, not surprising, since the idea apparently originated with that truth stretcher extraordinaire, former Alaska Gov. Sarah Palin.)

As you may have heard, that rhetoric resurfaced during town halls held by a few Republican members of Congress.

That idiocy came from language in the ACA that authorized Medicare to pay for voluntary end-of-life counseling. It was falsely projected as a “mandatory” activity every five years.

Some of the hysteria also stemmed from a specific clause in the ACA that said:

Establishes an Independent Payment Advisory Board to develop and submit detailed proposals to reduce the per capita rate of growth in Medicare spending to the President for Congress to consider. Establishes a consumer advisory council to advise the Board on the impact of payment policies under this title on consumers.

The fear, from the right-wing punditry was that bureaucrats would start to deny care to older, sicker Americans.

Well, the American Health Care Act leaves that provision in place, according to an analysis by the Kaiser Family Foundation:

Other ACA provisions related to Medicare are not changed, including:
* Increase Medicare premiums (Parts B and D) for higher income beneficiaries (those with incomes above $85,000/individual and $170,000/couple).
* Authorize an Independent Payment Advisory Board to recommend ways to reduce Medicare spending if the rate of growth in Medicare spending exceeds a target growth rate.
* Establish various quality, payment and delivery system changes, including a new Center for Medicare and Medicaid Innovation to test, evaluate, and expand methods to control costs and promote quality of care; Medicare Shared Savings Accountable Care Organizations; and penalty programs for hospital readmissions and hospital-acquired conditions.

So, is the GOP plan embracing death panels, or is Republican leadership simply admitting that they were lying all along to whip up paranoia?

March 14, 2017 I Written By

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

CMS is about to lose a top Medicaid official

Here’s the easiest prediction I will make this week: Dr, Andrey Ostrovsky, chief medical officer of the Center for Medicaid and CHIP Services, is about to lose his job after just six months.

How do I know this? Ostrovsky isn’t just privately opposed to the American Health Care Act — the newly released Republican “repeal and replace” of the Affordable Care Act. He tweeted his opposition to the bill yesterday.

And he made the likely fatal mistake of citing outside opinions that don’t square with those of the Trump administration. Indeed, the American Medical Association, American Academy of Family Physicians and American Academy of Pediatrics have all come out against the first iteration of the AHCA.

We know that President Donald Trump pays attention to what gets said on Twitter. We also know what the Trump White House thinks of dissension within the ranks. Ask longtime U.S. Department of Justice attorney Sally Yates about that.

On Jan. 31, Yates, who was serving as acting attorney general before Jeff Sessions had been confirmed by the Senate, got canned for opposing Trump’s executive order that cut off immigration from seven majority-Muslim countries.

And she wasn’t just fired. The administration questioned her patriotism by saying Yates “betrayed the Department of Justice by refusing to enforce a legal order designed to protect the citizens of the United States.”

Expect Ostrovsky to lose his job soon, in no small part because his tweet has so many likes and retweets. Perhaps it was a calculated move on his part?

March 9, 2017 I Written By

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

Health Wonk Review for the holidays

The final Health Wonk Review of 2014 is up (actually, it’s been up for five days, but I’ve been buried with deadlines until this morning), courtesy of Julie Ferguson  and the Lynch Ryan Workers’ Comp Insider blog. My Forbes.com post on the recent reality checks for healthcare wearables makes this biweekly review of the best of the healthcare blogosphere. (I also did a follow-up, featuring an ESPN “Sport Science” segment sponsored by Fitbit.) FWIW, the comments have been closed on the LinkedIn Digital Health Group item about my original post.

There isn’t much else in the realm of health IT in this edition of HWR, but there are some interesting discussions about the Patient Protection and Affordable Care Act, including an important question from Peggy Salvatore: To whom is accountable care actually accountable to? Yep, ACOs are right there in the Affordable Care Act, lest you think the Obamacare law is only about health insurance coverage.

Enjoy the recap, and enjoy the holidays, whichever ones you celebrate. I’ll see you in January.

December 23, 2014 I Written By

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