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!

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.

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.

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.

Yes, the Stage 2 ‘meaningful use’ proposal will be out before HIMSS

There have been a lot of reports of late that HHS will publish its notice of proposed rulemaking for Stage 2 of the “meaningful use” EHR incentive program some time in February. That information is based on an e-mail update from CMS.

I can go one better than that: The proposal will be out in the next three weeks or so, before the start of the annual HIMSS conference on Feb. 21. How do I know this? Check out educational session No. 90 from the HIMSS 12 program, set for the morning of Wednesday, Feb. 22. Speakers haven’t been announced yet, but here’s the description: “An overview of the recently published Stage 2 Notice of Proposed Rulemaking for the EHR Incentive Programs, including changes to Stage 1 requirements, new meaningful use requirements for Stage 2, and changes to clinical quality measure reporting for eligible professionals and eligible hospitals.”

Yep, the NPRM will have been “recently published” by the time HIMSS rolls around.

 

January 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.

Gingrich on EHRs in the 2009 stimulus

I don’t like to get political on this blog, but I’ve been thinking a lot about how the Newt Gingrich we’ve seen on the campaign trail of late is quite different from the Newt Gingrich who was a tireless advocate for health IT and EHRs from about 2004 to 2009.

Lately, Gingrich has, as primary candidates are wont to do, been pandering toward the more ideologically pure elements of his party, not addressing the center, as will be necessary during a general election. Notably, Gingrich has jumped on the “repeal Obamacare” bandwagon, essentially making the ridiculous argument that America does not need healthcare reform. That’s interesting, because Gingrich, after he left Congress, founded the Center for Health Transformation to push for technology-enabled health system improvement.

Back in 2004, Gingrich joined with strange bedfellow Hillary Clinton to advocate for a national, government-funded strategy to support adoption of health IT. That idea eventually morphed into the HITECH Act section of the 2009 American Recovery and Reinvestment Act, President Obama’s $787 billion stimulus legislation. Gingrich, like most Republicans, opposed the bulk of the stimulus, but he was an ardent supporter of HITECH. Here’s the proof: Read more..

January 29, 2012 I Written By

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

ONC HIT competency testing

Late last week, the Office of the National Coordinator for Health Information Technology opened six exams to test the competency of health IT professionals who have completed short-term training programs. I’m not quite sure how I feel about this. Is it a good thing for the federal government to offer these voluntary exams? After all, ONC is funding the development of HIT training curriculum for community colleges and providing lots of scholarship money. Shouldn’t the government expect to get a return on its investment? Or should the feds stay out of the testing process?

May 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.

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.