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Podcast: HIMSS CEO Steve Lieber: 2013 edition

Once again, as has become custom, I sat down with HIMSS CEO Steve Lieber at the organization’s Chicago headquarters the week before the annual HIMSS conference to discuss the conference as well as important trends and issues in the health IT industry. I did the interview Monday.

Here it is late Friday and I’m finally getting around to posting the interview, but it’s still in plenty of time for you to listen before you get on your flight to New Orleans for HIMSS13, which starts Monday but which really gets going with pre-conference activities on Sunday. At the very least, you have time to download the podcast and listen on the plane or even in the car on the way to the airport. As a bonus, the audio quality is better than usual.

Podcast details: Interview with HIMSS CEO Steve Lieber about HIMSS13 and the state of health IT. Recorded Feb. 25, 2013, at HIMSS HQ in Chicago. MP3, stereo, 128 kbps, 46.0 MB. Running time: 50:17.

1:00        Industry growth and industry consolidation
2:50        mHIMSS
3:45        Why Dr. Eric Topol is keynoting
6:00        New Orleans as a HIMSS venue
6:50        Changes at HIMSS13, including integration of HIT X.0 into the main conference
8:55        Focus on the patient experience
9:35        Global Health Forum and other “conferences within a conference”
13:00     Criticisms of meaningful use, EHRs and health IT in general
17:00     Progress in the last five years
20:45     Healthcare reform, including payment reform
22:30     Why private payers haven’t demanded EHR usage since meaningful use came along
23:50     Payers and data
26:28     Potential for delay of 2015 penalties for not meeting meaningful use
29:15     Benefits of EHRs
30:40     Progress on interoperability between EHRs and medical devices
32:52     Efficiency gains from health IT
35:27     Home-based monitoring in the framework of accountable care
36:55     Consumerism in healthcare
39:40     Accelerating pace of change
41:10     Entrepreneurs, free markets and the economics of healthcare
43:25     Informed, empowered patients and consumer outreach
46:30     Fundamental change in care delivery

March 1, 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.

Chart: Current state telemedicine legislation

Here’s a handy chart from the American Telemedicine Association showing the current status of telemedicine legislation in all 50 states plus D.C. Specifically, it shows which states have already mandated private and Medicaid insurance coverage for telemedicine services, as well as which states are considering such a law. (Medicare policy of course is set at the federal level.) This information is current as of this month.

 

State telemedicine legislation

February 21, 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.

Podcast: This time, I’m the interviewee

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

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

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

September 18, 2012 I Written By

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

A dubious honor from Health Wonk Review

For the very first time, I captured the top spot on the biweekly Health Wonk Review blog carnival, this time hosted by Dr. Jaan Sidorov of the Disease Management Care Blog. Unfortunately, I had to endure my dad’s untimely death after a miserable hospital experience in order to write the piece in question. But if it brings more traffic to that post and, more importantly, more awareness of multiple system atrophy (MSA) and the problem of poorly coordinated care and broken processes in hospitals, I’ll take it.

Since you’re here primarily for health IT, I’ll point you to a couple of relevant items that Sidorov summarizes. In a post actually written back in February, Martin Gaynor, chairman of the Health Care Cost Institute, discusses the organization on the Wing of Zock (the name is explained here) blog. The institute is aggregating claims information from the likes of Aetna, Humana, Kaiser Permanente, UnitedHealthcare and CMS to provide researchers with rich data sets related to healthcare costs and utilization.

“At its most basic, HCCI was formed because a better understanding of health spending can improve the quality of care and save money. If we generate information that makes a difference, then we will be a success,” Gaynor says.

Also, consultant Joanna Relth makes it known on the Healthcare Talent Transformation blog that she is no fan of ICD-10. “I’m sure that the intent of making this massive change to the codes is to improve the accuracy of diagnosis coding so providers will bill more accurately and insurance companies will pay providers and insureds in a more timely fashion. Seriously?? Did anyone ask a learning professional about how large a list is reasonable and at what point does the number of data points become impossible to follow?” she wonders in what comes off a little as an anti-government screed.

But I prefer to end this post on a happy note. In the comment section, Relth links to a video from EHR vendor Nuesoft Technologies that parodies Jay-Z’s “99 Problems.” Enjoy.

May 25, 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.

Sen. Whitehouse, make some more noise, please

I have railed more often than I can count against politicians and the national media for misleading or at least failing to inform the public on what health reform is all about. For me, it was quite refreshing to see an interview in the Washington Post with Sen. Sheldon Whitehouse (D-R.I.), attempting to shed some light on the parts of reform that have nothing to do with insurance.

“The Affordable Care Act is mostly known as an insurance expansion, expected to extend coverage to more than 30 million Americans,” started the post by Sarah Kliff. “But … a big chunk of the law is dedicated something arguably more ambitious: an overhaul of the American business model for medicine. ‘This is a very significant piece of the bill that has received virtually no attention because it’s so non-controversial,’ Sen. Sheldon Whitehouse (D-R.I.) told me in a recent interview.”

On Thursday, Whitehouse released a 52-page document outlining what he sees as the 47 changes the Patient Protection and Affordable Care Act is making to how care is delivered. That doesn’t even count the reforms in the HITECH section of the American Recovery and Reinvestment Act from a year earlier, by the way.

Health IT, of course, is a big part of reform.”The HITECH Act took important steps to restructure financial incentives to shift the pattern of health IT adoption. The HITECH Act’s Medicare and Medicaid incentive payments are encouraging doctors and hospitals to adopt and “meaningfully use” certified
electronic health records,” Whitehouse noted.

Also from that report:

Health information technology (IT) will radically transform the health care industry, and is the essential, underlying framework for health care delivery system reform. The ACA’s payment reforms, pilot projects, and other delivery system reforms are built with the expectation of having IT-enabled providers. In particular, the shift to new models of care, like ACOs, will rely heavily on information exchange and reporting quality outcomes. Indeed, the formation of ACOs is contingent on having providers “online” to transfer information and patient records, and report quality measures.

Whitehouse did discuss ACOs with the Washington Post, but there’s a reason why the interview appears on a page called the WonkBlog. This stuff is too complicated and wonky for the average person.

What isn’t complicated is explaining that throwing more money at a broken system, as the insurance expansion does, will not lower the cost of care. It also isn’t complicated to explain that tens of thousands of Americans needlessly die each year due to medical errors or low-quality care. Yet, more than a few defenders of the ACA have said that the insurance mandate would help guarantee “quality care” for millions.

Wrong!

The insurance expansion guarantees insurance coverage. It does not guarantee quality care. Whoever wins Friday’s Mega Millions drawing wouldn’t necessarily be able to buy quality care, either. Nor would Bill Gates, for that matter. You can’t get quality care unless you’re willing to address the causes of errors and adverse events. Period.

Sen. Whitehouse seems to understand that. I doubt too many other members of Congress do, despite the fact that a former colleague, the late Rep. John Murtha (D-Pa.), who had the “Cadillac” coverage so many people covet, died as a result of a medical error.

March 30, 2012 I Written By

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

Video: Dell Healthcare Think Tank at HIMSS12

The video from the Dell Healthcare Think Tank dinner at HIMSS12 last week, which I participated in, is now available. It’s long, but if you’re into health IT policy and healthcare reform, it probably is worth your time.

February 26, 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.

Podcast: Intel’s Eric Dishman on connected care management

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

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

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

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

October 26, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, 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.

Podcast: mHealth Initiative’s Peter Waegemann

In 2009, after 25 years of moving “Toward an Electronic Patient Record” (TEPR), the Medical Records Institute disbanded and its founder, Peter Waegemann, shifted his focus to mobile healthcare by creating the mHealth Initiative.

TEPR had grown into a rather substantial event, peaking at 3,800 attendees in 2004, when newly appointed national health IT coordinator Dr. David Brailer was the featured speaker. But attendance and vendor square footage rapidly declined after that, as much of the action in the realm of EMRs either moved to medical specialty societies or the huge HIMSS conference.

Taking a more content-driven than vendor-driven approach, the mHealth Initiative has tried its hand at conferences since last year. (I spoke and served on a panel at the organization’s 2nd mHealth Networking Conference last fall.) A week ago, the group held its third such event in that paradise for lovers of jet noise, Rosemont, Ill., and I sat down with Waegemann to record this podcast.

Podcast details: Interview with Peter Waegemann, chairman and founder of the mHealth Initiative. Recorded March 30, 2011, at the mHealth Initiative’s 3rd Networking Conference in Rosemont, Ill. MP3, mono, 64 kbps, 6.0 MB. Running time 26:02.

0:20     Transition from e-health to m-health after 25 years of running TEPR
1:50    “Total paradigm shift” for documenting and accessing information at the point of care
2:20     No country he’s seen has a complete, effective EMR yet
2:40    Movement from an industrial society to an “information society” of knowledge workers
4:40    Beyond voice communications
6:20    Behavior change in healthcare and adapting to technology
7:20    Lack of connectivity among mobile devices and shortcomings in current technology
8:55    The politics of standards for m-health devices and systems
10:40    Always “five years away”
11:20    Searching for the iPhone of home monitoring
12:00    iPad’s role in healthcare and its shortcomings
13:00    Apps
14:20    EMR vendors discovering mobile devices
15:25    Distinctions between wired health, wireless health and connected health
15:50    “Three pillars” of m-health
16:40     “Communication-enhanced healthcare”
17:35    Better care for less money
19:05    Cell phones in hospitals
20:30    Integration issues
21:00    Patients and younger physicians driving change
22:00    “Unified communications”
22:42    Payment for home monitoring
24:30    European approaches to m-health

April 8, 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.