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Health Wonk Review: Special SCOTUS edition

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

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

July 5, 2012 I Written By

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

ACA decision is a beginning, not an end, to health reform

I’ve spent a lot of time on social media since Thursday morning debating the meaning of the Supreme Court’s rather stunning decision on the Patient Protection and Affordable Care Act. It was stunning in that Chief Justice John Roberts, a George W. Bush appointee, sided with the four liberal-minded justices, but also stunning in that the court went against conventional wisdom by upholding the individual mandate on the grounds that it was a legal exercise of Congress’ constitutional right to levy taxes.

I had to remind a lot of people that this decision neither solves the crisis, as supporters have claimed, or turns us into the Soviet Union, as some on the lunatic fringe have suggested. Expanding insurance only throws more money at the same problem. This was my first tweet after I learned of the decision:

[blackbirdpie url=”″]

The cynic in me likes to point out that the individual mandate was an idea first conceived by the conservative Heritage Foundation and championed in Massachusetts by Mitt Romney. Both somehow now oppose the idea. The law that ultimately passed Congress was written by Liz Fowler, a top legal counsel to Max Baucus’ Senate Finance Committee who previously was a lobbyist for WellPoint. Her reward for doing the bidding of the insurance industry was for Obama to appoint her deputy director of the Office of Consumer Information and Oversight at HHS. This was insider dealing at its finest, as much a gift to insurers as the 2003 Medicare Prescription Drug, Improvement and Modernization Act was a gift to Big Pharma.

Of course, I initially was misinformed about the Supreme Court ruling because CNN jumped the gun (as did Fox News) and erroneously reported that the court had struck down the individual mandate on the grounds that it violated the Interstate Commerce clause of the Constitution. But so were millions of others.

I suppose that was fitting, since the national media have for more than two years been misinforming the public about what is really in the law. There are small but real elements of actual care reform — not just an insurance expansion — in there, but very few have been reported. The actual reform has been drowned out by ideologues on both sides. Here’s a handy explanation of most of what’s really there (it’s a good list but not exhaustive). The insurance expansion, the only thing people are talking about, really is just throwing more money at the problem. There is a lot more work to be done to fix our broken system.

What I consider real reform in the ACA includes accountable care organizations and the creation of the Center for Medicare and Medicaid Innovation. Along with the innovation center, CMS also gets the power to expand pilot programs that are successful at saving money or producing better outcomes. In the past, successful “demonstrations” would need specific authorization from Congress, which could take years.

Notice that there isn’t a whole lot specific to IT. That’s because the “meaningful use” incentive program for EHRs was authorized by the 2009 American Recovery and Reinvestment Act. Another key element of real reform that also is not part of the ACA is Medicare’s new policy of not reimbursing for certain preventable hospital readmissions within 30 days of discharge.

We need more attention to quality of care. Many have argued that tort reform needs to be part of the equation, too, because defensive medicine leads to duplicative and often unnecessary care. Perhaps, but lawsuits are a small issue compared to the problem of medical errors. Cut down on mistakes and you cut down on malpractice suits. Properly implemented EHRs and health information exchange — and I do mean properly implemented — will help by improving communication between providers so everybody involved with a patient’s care knows exactly what’s going on at all times.

All of these facts lead me to conclude that true healthcare reform hasn’t really happened yet. Look at this Supreme Court ruling as a beginning, not an end, to reform.


June 29, 2012 I Written By

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

Health reform is so much more than insurance

The headline above shouldn’t surprise regular readers or anyone who knows me. I’ve been saying for a couple of years to anyone who asks me about “Obamacare” or any other aspect of healthcare reform—and many people who haven’t asked—that the public debate and media coverage have been about insurance reform, not care reform, and health insurance is not the same thing as healthcare. I’ve publicly chided the national media, too.

Maybe that is changing. Last month, attorney Philip K. Howard, chairman of advocacy group Common Good (an organization working to “fill the substance void in the 2012 election by offering new solutions to fix broken government”), wrote in The Atlantic that no matter what the Supreme Court does with the Patient Protection and Affordable Care Act, healthcare still will remain inefficient and expensive. “The Affordable Care Act, aka Obamacare, strives for universal coverage. While it encourages pilots for more efficient delivery systems, the overall effect is to exacerbate the unaffordability of American health care. In this sense, the upcoming Supreme Court decision on constitutionality is just a side skirmish,” Howard said.

In other words, as I’ve been arguing for two years, the insurance expansion of this supposed comprehensive “healthcare reform” legislation is simply throwing more money at the same problem. Having insurance doesn’t assure you good care, nor will it by itself even reduce overall costs. It just shifts costs. There was more reform in the HITECH section of the 2009 American Recovery and Reinvestment Act, in the form of the $27 billion incentive program for “meaningful use” of electronic health records than there is in the part of the ACA being widely debated in this election year.

That’s why, as I pointed out Friday, I was happy to see that investigative journalism organization ProPublica has started a Facebook community for people to share stories of patient harm. And today, the New York Times discussed actual healthcare quality in one of its Sunday editorials (h/t Jane Sarasohn-Kahn). The Times highlighted efforts at Virginia Mason Medical Center in Seattle, Cincinnati Children’s Hospital Medical Center and hospital alliance Premier, saying, “It is a measure of how dysfunctional the system has become that these successful experiments — based on medical sense, sound research and efficiencies — seem so revolutionary.” Indeed.

By the way, my recent, controversial post arguing that faxing should be considered malpractice isn’t a new thought I’ve had. I just rediscovered my January 2011 commentary in Columbia Journalism Review about media coverage of telephone-based “telemedicine.” I ended the piece by advising fellow journalists to “start asking the health-care organizations you cover why they still rely on old-fashioned telephones and fax machines.” Malpractice or not, legal or not, it’s more than a decade into the 21st century, yet we still view healthcare through a 20th-century lens.

Or, as I also like to say, it’s quality, stupid.

June 3, 2012 I Written By

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


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.

Groopman explains patient empowerment to Colbert

The public is slowly getting the message that the doctor doesn’t always know best. Dr. Jerome Groopman, chief of experimental medicine at Beth Israel Deaconess Medical Center in Boston and a staff writer for The New Yorker, is out hawking his new book, “Your Medical Mind: How to Decide What Is Right for You.” Last night, he explained the idea of patient empowerment to a skeptical Stephen Colbert, or at least a skeptical character played by Colbert.

Colbert did make the common mistake of confusing health insurance with healthcare when he asked Groopman if the Harvard doc would testify before the Supreme Court on the upcoming case regarding the individual mandate in the Patient Protection and Affordable Care Act. People, they are two different things!


The Colbert Report Mon – Thurs 11:30pm / 10:30c
Jerome Groopman
Colbert Report Full Episodes Political Humor & Satire Blog Video Archive

October 4, 2011 I Written By

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

More reasons why CMS needs Berwick

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

The crowd ate it up.

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

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

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

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

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

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

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

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

March 20, 2011 I Written By

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

Park: Government relies on private sector to innovate

In case anyone was still thinking the Patient Protection and Affordable Care Act  was an insidious plot for government to take over healthcare, here’s HHS CTO Todd Park—you know, the co-founder of athenahealth—talking at this week’s South By Southwest Interactive conference in Austin, Texas. In this video, Park echoes the sentiments of his former business partner Jonathan Bush from an interview Bush gave me at HIMSS last month in saying that the government’s job isn’t to innovate but rather to lay the foundation for the private sector to innovate.

This is particularly important in the wake of my strong defense of Dr. Donald Berwick and the Center for Medicare and Medicaid Innovation.

March 15, 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.

ONC opens comments on federal HIT strategic plan

The Office of the National Coordinator for Health Information Technology today opened a four-week comment period on proposed revisions to the Federal Health IT Strategic Plan (pdf). Last updated in 2008, the plan spells out ONC’s strategy for meeting national health IT goals for the five-year period beginning in 2011. The HITECH Act requires this revision.

According to a blog post by national coordinator Dr. David Blumenthal:

Some components of the Plan may already be familiar, including the Medicare and Medicaid Electronic Health Record Incentive Programs and the grant programs created by the HITECH Act, which are creating an infrastructure to support meaningful use. However, the Plan also charts new ground for the federal health IT agenda:

  • In Goal I, the health information exchange strategy focuses on first fostering business models that create health information exchange, supporting exchange where it is not taking place, and ensuring that information exchange takes place across different business models.
  • In Goal II, we discuss how integral health IT is to the National Health Care Quality Strategy and Plan that is required by the Affordable Care Act.
  • In Goal III, we highlight efforts to step up protections to improve privacy and security of health information, and discuss a major investment in an education and outreach strategy to increase the provider community and the public’s understanding of electronic health information, how their information can be used, and their privacy and security rights under the HIPAA Privacy and Security rules.
  • In Goal IV, we recognize the importance of empowering individuals with access to their electronic health information through useful tools that can be a powerful driver in moving toward more patient-centered care.
  • In Goal V, we have developed a path forward for building a “learning health system,” that can aggregate, analyze, and leverage health information to improve knowledge about health care across populations.

ONC is accepting comments through April 22 via the blog site.


March 25, 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.

Extormity throws down

I just received the following e-mail from Extormity:

Electronic health records vendor Extormity, dismayed at the ambitious scope of ARRA meaningful use criteria, is challenging National Coordinator for Health Information Technology David Blumenthal to a “rumble.”

“This call for physical confrontation is an extension of our ‘Whine into Water’ lobbying initiative, where we have joined with other large and inflexible EMR vendors to raise concerns about the difficulty of achieving meaningful use as currently defined,” said Extormity CEO Brantley Whittington. “If enough of us bellyache about these aggressive criteria, we are hoping they will be watered down such that meaningful use is effectively rendered meaningless.”

“However, in the event our campaign is unsuccessful, I would like to engage David Blumenthal in hand-to-hand combat at an upcoming HIT conference,” added Whittington. “Can you imagine what a mano y mano cage match would do for HIMSS attendance? I’m not proposing actual fisticuffs, rather, I suggest we thumb wrestle — best two out of three and the victor gets to set final meaningful use criteria.”

While other EMR vendors are refraining from public comment, an officer at another large HIT organization expressed tacit approval. Speaking on condition of anonymity, this executive was supportive of Extormity’s efforts. “Current criteria will reward nimble, flexible, innovative vendors who are focused on affordable, interoperable, web-based solutions designed to improve patient care. We question the audacity of the government in setting criteria designed to improve clinical outcomes and reduce costs — this callous irresponsibility will punish those of us with expensive client-server solutions that require physicians to abandon established workflows as they implement our hard-to-use applications. The trickle down effect would have a disastrous impact on our economy — if our profits fall, our lavish executive bonuses will be eviscerated and we will have less to spend in the Hamptons.”

Asked if Mr. Blumenthal should be concerned about a potential threat to his physical safety, Whittington was nonplussed. “Since Extormity is a fictional organization developed as a parody of lumbering, expensive and ineffective EHR vendors, and I don’t actually exist, there is no actual hazard. With that said, I know jujitsu.”

I’m not aware of a response by Blumenthal.

December 15, 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.

David St. Clair on privacy

It’s a few weeks old and you may have seen it elsewhere, but I see no harm posting this commentary from David St. Clair, founder and CEO of care management software company MEDecision. You’ll note that the CNN video he references also appeared on my blog last month.

Consumers Need All of the Facts in the Privacy Debate

By David St.Clair

The economic stimulus package that President Obama has signed contains upwards of $20 billion to create electronic health records for most Americans within five years. The president has been very outspoken in his belief that EHRs are essential to health care reform and that the subsequent savings they’ll generate will help to strengthen the larger overall economy.

Whenever the subject of proliferating EHRs catches the national spotlight, you can bet that debates about privacy aren’t far behind. Indeed the privacy issue has already started to gain some traction in the media. In this video clip, CNN’s Campbell Brown and Elizabeth Cohen examine how easy it is for someone to obtain private medical information online by simply using someone’s Social Security number and date of birth.

While this assessment may be accurate, it’s a bit light on the fairness scale. Brown and Cohen only make a very brief mention of facts like President Obama’s plan to appoint a chief privacy officer and to implement unprecedented privacy controls to safeguard the EHR transformation. Instead they emphasize the more sensational angle implying that electronic health information just isn’t safe. They also seem to downplay the fact that a simple thing like creating a password can protect one’s private information.

I suspect the privacy issue is going to reach a crescendo in the coming months, and it’s very important that Americans have all of the facts. There are unfortunately people in the world who are going to try to illegally obtain and misuse private health information. But that doesn’t mean we should just write off EHRs as a bad idea. We simply need to be vigilant and proactive in incorporating the highest security measures into the planning process — which the president has done. To borrow an analogy from a close colleague: we don’t stop building roads because some people drive drunk. We punish the drunk drivers and continue building roads because of the tremendous benefits they bring to the rest of our law-abiding society. There is too much at stake for the health care system and the nation’s economy to allow over-dramatized and misperceived weaknesses in EHR security to thwart progress.

Additionally, to make the privacy debate a fair one we must ask what’s more dangerous: the potential misuse of information or simply not using information at all? Should we put the privacy of an overwhelming minority of people ahead of safer, more efficient, more affordable and potentially life-saving health care for the overwhelming majority? In reality, the only people who stand to be harmed by an unlikely EMR privacy breach are celebrities and other high profile individuals. Even if someone were to gain access to the average person’s health information, there isn’t much they could do with it, other than cause that person some personal embarrassment. In a very real sense, the question then becomes whether we value the privacy of information more than its potential to help us lead healthier lives.

Without question we must make ensuring privacy a top priority in any plans to implement EHRs. I’m confident that the Obama plan does so and, in fact, I think we’ll see even stronger controls than we may have previously imagined. No EHR is going to come with guaranteed safety, but I would argue that the risk level is the same or less than that associated with online retail and banking transactions. The public needs to understand this. It is up to those of us in the industry to ensure that the facts are clear and readily available. Hopefully the media will choose to report all of them so that Americans can form opinions based on complete information.

March 15, 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.