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79 posts categorized "Universal Health Care"

July 02, 2009

2010 MPFS: CMS proposes 21.5% physician pay cut (yes, really)

Let's go down the rabbit hole with the federales. 

Remember the Sustainable Growth Rate, that congressional hedge against inflation of health care costs, specifically payments under the Medicare Physician Fee Schedule?  Well, the CY 2010 MPFS went on display yesterday, and is due to be published in a couple weeks.  As written, the rule would (among other things) fully implement the SGR by cutting physician payments 21.5% (see the press release).  That's because Congress has overridden every other cut mandated by the law since 2002, yet has not taken the time to rethink it -- even though it called for a review in 2005's DRA, and MedPAC obliged in 2007.  To cut to the chase, MedPAC recommended that Congress either (a) come up with another cockamamie formula or (b) repeal the SGR and develop incentives for providers to provide higher quality care at lower cost.  Yes, they've done a fine job so far . . . .

So, we all know that Congress will step in before the rule takes effect January 1, 2010; perhaps it will be in a systematic way this time, however, with a real replacement for the SGR wrapped into a broader health care reform bill.  The Tri-Committee bill in the House (see sec. 1121, p. 181) is the only leading bill that addresses this issue head-on, as far as I know (please let me know if I'm missing something), though it does not include a radical enough reformation and seems to fall in line with MedPAC recommendation (a).

As the WSJ Health Blog notes, another part of the crazy logic at work in the draft rule is a CMS proposal to carve out reimbursement for physician-administered drugs ($87.5B over ten years, per the CBO) from that which is subject to the SGR.  That would help with the narrow issue of how-many-percentage-points-of-the-SGR-can pass through the eye of a needle, but obviously doesn't address the fundamental systems issue.  (I'll take (b) for $2.4 trillion, Alex.)

There's plenty of other goodies in this draft rule -- especially around imaging -- but the big across-the-board cuts certainly deserve the headline.  For example:

  • Capital reimbursement for physician-office diagnostic equipment was originally calculated by CMS based on the assumption of a 50% utilization rate.  Since the actual utilization rates are much higher, that assumption is now being formally thrown out the window.
  • Under MIPPA, imaging providers will be subject to new accreditation requirements as of January 2012; accreditation organizations are identified in the rule, and additional controls will be forthcoming in separate rulemaking.
  • Finally, more measures are being added to the PQRI set, and automatic EHR-to-CMS reporting is being explored (as is the case with hospital RHQDAPU reporting), as pay-for-reporting (in lieu of meaningful pay-for-performance) continues at the Federal level.

Bottom line: This is a complicated set of issues, but it is only one of many that Congress and the President hope to have all wrapped up neatly by November.  Perhaps a post-SGR approach to physician payment will help build the coalition necessary for meaningful systemic reform.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

June 23, 2009

America's Agenda: Health Care For All - Conversation with Dick Gephardt on bipartisan business-labor-payor coalition prodding policymakers into action

I had the opportunity to speak with Dick Gephardt and Mark Blum yesterday, courtesy of America's Agenda: Health Care For All.  Mark is the organization's Executive Director.  Dick Gephardt is a board member and is also . . . Dick Gephardt.  The organization has been engaged in some bipartisan efforts to promote health care reform at the state level (e.g., Vermont), and is now trying its hand at the national stage, having sponsored a series of "summit conversations" over the past few months.  This is one of a new breed of political action committee, which strives to bridge gaps between Democrats and Republicans (Tommy Thompson is also a board member), Big Labor and Big Business and Big Healthcare (members range from SEIU to IBM to PhRMA to Catholic Healthcare West), and promote health care reform.  As is true of many proposals on the table these days, the group's consensus document on national health reform takes the mom-and-apple-pie approach, endorsing a federal disease prevention initiative, a national strategy to improve efficiency and coordination of chronic disease care, strengthening comprehensive primary care, improving evidence for practice guidelines and quality standards, aligning incentives to promote best practices, promoting HIT to reduce waste and enable care coordination, and guaranteed access to care.  The $2.4 trillion question remains: How do we pay for all this health care goodness?

Gephardt was in a leadership position in Congress during the "HillaryCare" campaign in 1993-94.  In his view, comprehensive reform stands a better chance now because the Obama Administration has set out basic goals to be achieved that are straightforward and positive, and has turned it over to Congress to work out the details -- in contrast to the HillaryCare plan drafted in private by a panel of experts and dumped on legislators' desks.  "In the end, the only thing that matters is votes in the House and Senate," Gephardt said, and the only way to secure those votes is to engage Senators and Representatives in the development and drafting of the bills, which was not done in the Clinton era.  His other observations: Stakeholders in the process have remained engaged this time around; in the '90s, many big stakeholders opted out early and just attacked the process.  In order to succeed, a health reform plan needs to offer tangible benefits to the 85% or so of the population who already have health insurance (e.g., savings or efficiencies); otherwise there can’t be a successful political outcome.  "We can't just talk about who do we tax to cover the uninsured; we need to talk about savings for everyone."

I asked Gephardt whether and how the spirit of bipartisanship that we see these days among many prominent former government officials "reaching across the aisle" could be instilled into current political leaders.  His observation: it's hard, given the degree to which the parties have become polarized, yet some Republicans, notably Senators Grassley and Enzi (ranking minority members on key committees), are able to engage in policy discourse.  Gephardt noted that given the range of views within the Democratic Party, there needs to be as much attention paid to keeping the conservative and progressive wings of the party engaged as there is to keeping lines of communication open across the aisle.  Gephardt and Blum both said that there seems to be more common ground this time around because business, labor and provider communities are all feeling pain and recognize that reform is needed.  However, it seems to me that shared pain does not guarantee shared views on the right prescription to ease that pain.  The prescription involves a lot of money, and the stakeholders under various plans floating around Congress these days are weighing in, making swift passage seem less likely as time goes on.  See, e.g., the letter from AHIP to Sen. Kennedy, as reported in the Wall Street Journal.

Blum pointed to the organization's success in helping garner support for the Vermont health care reform plan enacted a couple of years ago.  After the plan was initially vetoed by the governor, and his approval ratings didn't budge, America's Agenda came to town and recommended taking a different tack, based on polling data showing that the key issue for Vermonters (most of whom were already insured and were unmoved by the rhetoric about universal coverage) was concern about being able to continue to pay for one's own health care in the future.  Focusing on that angle led to passage of the bill and its signing by the governor, Blum said.  A more recent model for success is the West Virginia five-year plan, enacted within the past month.  Again, local conditions dictated strategy and tactics.  And again, it will be very interesting to see whether and how the broad promise enacted will ultimately be funded and implemented.

Translating this success to the national stage requires identifying the health care delivery system reforms that can drive down costs, according to both Blum and Gephardt.  If everyone's covered, they say, we can spread costs over more premium payors and manage chronic conditions more effectively and efficiently.  I pushed on this point, given the evidence demonstrating that preventive care doesn't necessarily save money in the long run, because (a) preventive care for all is more expensive than treating the small numbers of cases of any illness or injury that could have been prevented and (b) the people who benefit from such care tend to live longer and eventually suffer from costly illnesses.  Blum insisted that employers such as IBM have found that given a long enough time horizon (10-15 years), the savings are there, and preventive care pays off (4:1).  I am not convinced; I think that given an even longer time horizon -- e.g., into retirement -- the costs will spike, but then that's no longer IBM's problem . . . it's everyone's problem.  Now, I'm not opposed to primary and preventive care; I would just prefer that the trade-offs and consideration of all costs and benefits be explicit.  This is a big social policy issue, not just a health care issue, given the amount of money that's at stake and the potential for rationing engendered by the price tag.

Other topics touched on included the question of whether for-profit insurance companies should be permitted to reap the financial benefit of health care expenditure savings (Gephardt pointed to legislative language calling for community rating, limitation of pre-existing condition exclusions and, in the House Tri-Committee health care reform bill released as a discussion draft within the past week, regulation of medical loss ratios so as to prevent windfalls to commercial insurers; this last provision seems destined for the dustbin of history sooner rather than later).  In addition, I asked whether contributors to America's Agenda's campaigns are skewing their focus (Blum said the $12 million contributed by PhRMA to the SCHIP fight was firewalled away from the current campaign regarding health care reform).

Bottom line: America's Agenda has done a good job of bringing the policy debate out of the back rooms and onto the internet, and has also made important contributions to enabling state-level reforms.  It remains to be seen whether this new stripe of activism will gain significant traction in Washington, or whether the business-labor-payor alliance will simply break down as we get closer to the massive financial issues at stake in the debate.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

June 11, 2009

Health Care Reform edition of Health Wonk Review is up

Joe Paduda does a great job pulling together the best of recent policy posts from the health blogosphere -- and tops it off with some insightful wonkishness of his own -- in today's edition of Health Wonk Review at Managed Care Matters.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

Blog Talk Radio: David Harlow featured in health care reform discussion on Gregg Masters' Net Health Reform

I had the pleasure of discussing the current crop of health care reform policy options with Gregg Masters and a number of callers today on Blog Talk Radio.  The hour-long show is available for your listening pleasure here (streaming or download).  Please let me know if you like the content and/or format.  Gregg (aka @2healthguru on twitter, where we first met) and I plan to produce future shows and are interested in your comments and suggestions on focused topics for discussion.

Thanks for listening and for your feedback.

For further reading, some of the materials we discussed include the three Senate Finance Committee policy options reports and related materials, Obama's letter to Senate Democrats, his radio/internet address from last weekend, Senator Kennedy's draft Affordable Health Choices Act, and the Tri-Committee draft released by the House Committees on Ways and Means, Energy and Commerce and Education and Labor.  There are a number of milestones on the march through committees and to the floors of both chambers, and on to the President's desk in October/November.  And finally, a useful tool for those of you keeping score at home is the Kaiser Family Foundation health reform proposal comparison.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

June 08, 2009

Health Care Reform: Two out of Three Ain't Bad?

Folksy ads for a local furniture store chain 'round these parts proclaim "quality, comfort and price; that's nice."  In the continuing saga of slouching towards health care reform, we need to deal with quality, access and cost.  The problem is, we can't really do everything at once. 

Now that Obama has weighed in again on the subject -- the weekend radio and internet address, following on the heels of his letter to a couple dozen senators on health reform priorities -- Paul Levy has quite the discussion going at his blog, Running a Hospital, after suggesting that not all of the President's goals can be achieved at once.  We're in agreement that the health care reform effort is balanced on a three-legged stool, and I would concur that the current discussion in Washington is tending more towards the let's-fix-everything-all-at-once end of the spectrum, which is untenable.  I've said it before and I'll say it again: what we need is incrementalism, baby.

Here in the People's Republic of Massachusetts, we started with coverage, which is as good a place as any.  I would observe, though, that the starting point (along with a variety of other characteristics of the Massachusetts approach) are idiosyncratic and a product of the political wrangling/horsetrading that went on in order to get all stakeholders into the big tent.  (We're experimenting in just one of 50 laboratories here.)  Another (larger) playing field, and different (more) players are likely to yield a different set of compromises.  And that's OK, as long as the ball gets moved a bit further down the field (to mix a few metaphors).  I thought Obama's earlier approach, circa White House Health Care Summit ("you know what I'm looking for, guys; send me a bill I can sign") was politically brilliant; getting down and dirty on the details should be left to the operatives, so that Chuck Grassley doesn't get to score points by tweeting about Obama sightseeing in Europe over the weekend (though, gee, did he forget it was D-Day?).  I thought Obama better appreciated the need for results in this arena vs. taking the opportunity to do a little grandstanding.

So, I'd like to see Obama back off: more looking Presidential; less arm-twisting.  Staking out the range of options to be considered is a good thing, and hanging back a bit until there's a solid bill on his desk -- understanding that the White House is certainly involved in the private discussions leading up to such a bill being finalized -- would be even better.  Seems to me that's the clearest way forward for now.  While there is the potential for taking some giant steps this year, I'm OK even if the end result is less ambitious than is now hoped for.  Why?  Because I believe incrementalism is the way to go here, and it will end up being the first step of a long journey.

If you're interested in discussion of the leading health care reform policy and payment options on the table, please join Gregg Masters and me on Blog Talk Radio this Thursday, June 11, 12:00 Noon Pacific, 3 PM Eastern, and follow the continuing conversation here, there and on twitter.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

March 31, 2009

Health insurance mandates: Geez, good thing Obama isn't pushing them, 'cause he'd get tied up in litigation for forever

San Francisco's municipal health insurance mandate is in the news again this week.  The 9th Circuit Court of Appeals upheld the mandate in September (after sturm und drang and litigation over the San Francisco health insurance mandate going back almost two years now), and the local restaurant association has taken the fight to the Supremes.  The association suffered a setback this week, as the high court refused to enjoin enforcement of the law pending appeal.  We'll see this fall whether the Supremes will hear the case.  The program has extended health benefits to tens of thousands of folks, and is set to underwrite some new clinics as well. 

The challenge comes out of the arcane left field that is ERISA pre-emption jurisprudence.  The Circuit Court's response last fall, per the local paper:  "San Francisco was exercising its legal authority to protect its residents' welfare and was not regulating employee benefit plans, because employers have a choice of insuring their own workers or paying a fee to the city."

As I've observed before, the fact that an ERISA challenge has not been brought in Massachusetts is a testament to the coalition-building that went on across all sorts of lines before the Massachusetts plan was enacted.  For all its faults, the Massachusetts experience -- like the San Francisco experience -- serves as a laboratory environment in which experimentation is taking place.  Here's hoping that a workable national health care reform plan -- backed by a solid coalition -- comes out of all these experiments and the continuing national discourse on the subject.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

March 19, 2009

Health Wonk Review: Spring has just about sprung

Michaels S C Welcome to Health Wonk Review, where everyone is above average.  We enjoy above-average health care costs per capita, above-average uninsured rates, and above-average obsession with health care reform.  That's what it's like today in America.  Our president has said, Change has come to America.  In the words of Robert Hayden's [American Journal]:

america     as much a problem in metaphysics as
it is a nation earthly entity an iota in our
galaxy     an organism that changes even as i
examine it     fact and fantasy never twice the
same     so many variables

Like Schrodinger's cat, America's health care system seems to change in the changing light as we examine it; one thing we can all agree on is that it needs some work. 

Franz Kline Steve Martin We begin with some broad brush strokes on form and amount of spending:

Len Nichols presents HEALTH REFORM: Moving Past the Impasse on the Public Plan | New America Blogs posted at New Health Dialogue

Maggie Mahar presents Health Beat: Thinking About Dr. Atul Gawande’s Congressional Testimony Part 1: Why Health Care Reform Will Require Additional Spending at Health Beat.

Lewis Hine Mechanic One cost, no matter what the payment system, is labor.  Lynn Nicholas, President of the Massachusetts Hospital Association writes about some pending changes to labor laws that might make it easier for labor to unionize, presenting the favored position of a non-union shop as one of worker, rather than employer, preference.  See Keeping Communication Lines Open in the Healthcare Labor Debate at CommonHealth, the Massachusetts health care reform blog of WBUR (a Boston NPR affiliate).

Who Will Pay for Prescription Drugs? asks Adam Fein at Drug Channels. CMS projections show that the government will have a very strong hand in managing retail drug spending and shaping the future of drug channels.  How will that affect pricing and R&D?  Richard Fogoros (DrRich) presents A Brilliant Plan For Preserving Pharmaceutical Progress at The Covert Rationing Blog, saying, The title says it all. Can we have our cake (drug price controls) and eat it too (continue drug innovation)? DrRich says, yes we can!  Check out his proposal.

Pills My dad used to say he wanted to listen to a radio station that broadcast only good news (not Good News, just good news).  Merrill Goozner, of GoozNews, suggests this week that there ought to be a journal dedicated solely to publishing negative results -- as soon as they're known -- as he is all hopped up due to delayed publication and/or suppression of data on adverse effects of drugs.  These issues in general, and a couple of current cases he discusses, have policy implications for the new leadership at the FDA.

At InsureBlog, Mike Feehan has a piece on Wellpoint's recent spinning off of its in-house PBM, About Wellpoint's PBM Auction, and future implications for prescription costs.


Ill and Uninsured in Illinois gives us a simple but eloquent presentation of the difficulty of accessing specialty care while uninsured: The Wait for Cook County Health Care.

At the other end of the spectrum, Health Access WeBlog's Beth Capell asks What are gold-plated benefits anyway? An interesting question, now that the president has indicated that he is open to signing a bill including taxation of health benefits.  (As an aside, Obama's approach -- White House Health Care Summit with stunning transparency, concluded with an invitation to Congress to send him a bill consistent with the policies he articulated throughout the campaign -- is both a refreshing change from the Clinton years and a strategy likely to insulate him from criticism on the exact contours of the plan when it reaches his desk.)

Mao_tse_tungJared Rhoads presents Less government, not more at The Lucidicus Project, discussing the recent report by Physicians for a National Health Plan (the single payor proponents).  I spoke with PNHP's David Himmelstein a little while back, and while he has a compelling argument for adopting a single-payor plan in this country (the savings would be impressive), I still believe that the more pragmatic approach is to make incremental changes in the system before us. 

Taking our cue from Dr. Himmelstein, we begin a bit of a grand tour by visiting our neighbor to the north. 

North of the border, Sam Solomon asks Can Canadian doctors fire their patients? at Canadian Medicine, and says in short, yes, but carefully.

At BNET Healthcare, Ken Terry writes that Massachusetts Needs to Deal With Primary Care Crisis, saying that while proponents of the healthcare reform program in Massachusetts tout it as a model for the entire country, and detractors point to the program's rapidly rising costs, neither side is really focusing on the need for better access to primary care in the state. He also observes that retail clinics are expanding in Massachusetts, and community health centers are pulling in federal cash for expansion.  One observation: retail clinics in Massachusetts are not currently expanding as they cannot find nurse pratitioners to hire.  Also, on a national level, Minute Clinic recently shuttered 90 sites for the season.  Even if they were growing, they are no substitute for primary care.

Looking at a new model of physician practice -- available 24/7, untethered to most of the traditional trappings of a physician practice (including that old-fashioned trope of accepting insurance payments), Ted Eytan, MD is Now Reading: Take Two Aspirin And Tweet Me In The Morning: How Twitter, Facebook, And Other Social Media Are Reshaping Health Care.

Great_Dictator_globe_scene_academy_print_bigGrrlScientist shares her overseas medicine story, Finnish Emergency Medicine: One American's Experience at Living the Scientific Life.  Seemed to work well for her without instantaneous contact back home.  (See my own tale of a close ecounter with an overseas health care system last year as well.)

Here at HealthBlawg, I recently interviewed the CEO of Satori World Medical, a medical tourism company that offers a twist: through an HRA, it funds patients' future years' insurance premiums with a portion of the savings their employers or insurers enjoy as a result of their overseas medical procedures.

Closer to home, many doctors are now leery of online ratings sites, and have started using a service, Medical Justice, to get patients to agree not to post negative reviews as a condition of being taken on as patients.  Dmitriy at Trusted.MD has been following this issue for a while and offers some insights.

Marx Brothers (A Day at the Races)_04_scrubbed_in Jaan Sidorov presents The Worrisome Outpatient Trend: What Does Disease Management Have to Offer? posted at Disease Management Care Blog.  Chronic care consumes 75% of the health care dollar in this country, and needs to be better managed.  Outpatient chronic care is a significant part of the equation.

Care management is also the theme of Julie Ferguson's post on The effect of obesity and other comorbidities on workers comp at Workers' Comp Insider.  In light of a new report which shows that workers comp medical claims can cost three times as much when the injured employee is obese, she makes the case for breaking down the silos between employer-based occupational health and general health programs.

David Williams' post on Wal-Mart and eClinicalWorks over at Health Business Blog concludes with a healthy bit of skepticism about this new EHR offering to small physician practices.

Using the cost per doc put out by Wal-Mart, John Moore does some calculations, and shows in his post The HITECH Challenge: Is $19B Enough to Drive HIT Adoption at Chilmark Research that docs getting wired and getting HITECH incentive dollars will be engaged in a money-losing proposition -- they'd actually be better off financially not implementing EHRs and getting hit with the penalty a few years down the road. 

Speaking of Wal-Mart, it bears mentioning that this day in history marks the anniversary of the Civil War Battle of Bentonville (No, not that Bentonville; the battle was in North Carolina.)

Tinker Ready, at Boston Health News, shares some insights from John Glaser, CIO of Partners Healthcare, on getting HIT right.

Shahid N. Shah presents Client/Server vs. ASP/Web-Based in Healthcare IT posted at The Healthcare IT Guy, since with the HITECH Act and stimulus bill making news, many users are asking if they should purchase software and use it on premises or if they should use a "cloud" package or an ASP/web-based solution.

Metropolis5 In addition to jump-starting HIT, current legislation is giving a boost to research funding.  One pot of funds is time-limited; Glenn Laffel looks at Beaker Ready projects ready for NIH funding at Pizaazz.

Jason Shafrin reviews some of the pros and cons of establishing a government body to conduct cost effectiveness research in Should the U.S. get NICE? at Healthcare Economist.

In The Color of Money: What Sort of School Doesn't Pay Its Faculty to Teach? Roy Poses at Health Care Renewal puts academic medicine on the spot, saying that some leaders have abandoned core missions in favor of collecting "taxes" from medical faculty, which makes faculty more dependent on commercial interests.  Strong words indeed, and an issue that needs to be rolled out front and center together with other payment issues if there is to be a wholesale revamping of health care financing in this country.

For those brave enough to enter the land of credit default swaps, Joe Paduda, at Managed Care Matters, examines the reasons for propping up AIG and why it may fail anyway.

And finally, to leave you with some doom and gloom from The Health Care Blog to ponder, Brian Klepper and David Kibbe ask Is the healthcare economy rightsizing?

Thanks for visiting HealthBlawg for this edition.  Please see me on twitter too, and join us again next time for Health Wonk Review.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

March 08, 2009

The broken health care system; the White House summit; prospects for the future

We all have war stories about negotiating the health care (non) system.  Today's installment is courtesy of Jeff Krasner, health care reporter for the Boston Globe.   Jeff, like the readers of this blog (I would hazard to guess), is better-equipped than most to deal with the medical-industrial complex.  If the cognoscenti have this much trouble, imagine how poorly things are going for others out there. 

So what's the solution?  President Obama has kicked things off with his White House Health Care Summit last week, and now he's taking the show on the road.  The summit was a masterfully-executed exercise in transparency (live-streaming opening and closing sessions, as well as five simultaneous breakout sessions) and the closing session had a great vibe.  Some of the video is archived by C-SPAN, and here is the twitterstream from part of the summit.  My own twitter conclusion: "Good vibe in the rm, excitement, not much new substance, POTUS elegantly dumps responsibility for HC reform in Cong's lap."

Interest groups (now known as stakeholders) that worked to ensure that Congress didn't even have legislation to send to Bill Clinton for signature are now somberly thanking Obama for a seat at the table.  Obama has wisely taken himself out of the fray and has committed to offering input from the sidelines, just enough to ensure that the bill to be crafted by Congress works within the administration's framework.  Since Baucus and Kennedy (to name but two) already have plans in the works, it is not too much to expect that Congress will engage on this issue.  It remains to be seen whether the engagement will be productive enough to yield signature-ready legislation by year-end.  In addition, we are all waiting for the administration's elucidation of the HITECH Act necessary to move forward with its full implementation.

With any luck, in the not-too-distant future, we can all look back at Jeff Krasner's column and laugh.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

March 01, 2009

Slouching towards HITECH Act implementation

I attended the Transforming Healthcare Summit in Boston last Thursday evening, saw a bunch of old friends and met some new ones.  About 500 people turned out for the event.  It featured a keynote by Jim Roosevelt, CEO of Tufts Health Plan.  He was excited about the comparative effectiveness provision of the HITECH Act, preventive care advances, and the opportunity to translate some lessons from the Massachusetts experience with universal health care coverage to the national arena. Jim's talk highlighted four key issues that he believes are the central issues of the health care system that we all need to grapple with (not that they are immediately soluble problems, but they demand our engagement):

1.  Ensure quality and effectiveness of heath care services, which may be facilitated by broader HIT adoption, chronic disease management programs, P4P programs, prevention and wellness programs.

2.  Reverse the growing shortage of PCPs

3.  Improve transparency of health care cost and quality.

4.  Address racial and income disparities.

Aspirational goals, and a tall order, to be sure.  Jim comes by such goals honestly; as his introduction noted, he is FDR's grandson.

These opening remarks were followed by a panel discussion moderated by Scott Kirsner, blogger and columnist at the Boston Globe.  The panel included Roosevelt, Charlie Baker, blogger and CEO of Harvard Pilgrim Health Care, John Glaser, occasional blogger and CIO of Partners Healthcare, and Jonathan Bush, CEO of athenahealth.  It was a freewheeling discussion punctuated by a bunch of good-natured ribbing among the panelists (especially once it was established that Roosevelt was the only Democrat on the panel, and the suggestion was made that the three other panelists were perhaps the only Republicans in Massachusetts). 

The meeting was serendipitously scheduled just after the signing of the stimulus package, including the HITECH Act (starts on p. 112 of the stimulus package, or ARRA), which provided much fodder for the evening's discussants.  It was a lively conversation, but perhaps a bit too soon after the signing, as there are still some significant open questions regarding implementation.

Two important examples:

  • What does "meaningful use" of EHRs mean?  Providers engaged in "meaningful use" of EHRs are eligible for the stimulus incentive payments.  The term will have to be defined in regulations. John Glaser expressed the hope that "meaningful use" is defined so as to include a requirement of communicating aggregated patient data to enable further development of evidence-based medicine, one of the key justifications that has been offered for computerizing medical records.

  • What will the new EHR certification body look like, and what EHR certification standards will be used?  Many observers are concerned that CCHIT will, by default or inertia, end up ensconced in this position, using existing standards.  John Halamka, who has a bit of an inside track on this sort of thing, expects that "NeHC will become the standards committee and will create value cases that contain standards and architecture for HITSP to harmonize and CCHIT to certify."  Read his whole post.

To get more of a sense of the evening, and to see an archived "live-tweeted" event, check out the consolidated twitterstream of everyone who tweeted the event.  If that's too overwhelming, take a look at just the HealthBlawger's twitterstream.  The links go to the oldest page of each twitterstream; read up, and page back to the newer pages to read in order.

Finally, for some "CEO on the street" sound bites collected after the panel discussion, check out the one-minute interviews with several health care CEOs in the audience, at David Williams' Health Business Blog.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

January 27, 2009

David Harlow speaks at retail clinic conference

I am at the Retail Based Health Clinics Congress in Las Vegas.  I tweeted yesterday's proceedings (tomorrow's should be available at the same link) -- that is, except for my own presentation, which is posted below for your viewing pleasure.  There has been an interesting exploration of the range of services and models currently being provided and that may be provided in the future at retail clinics.  To my mind, the key questions are: How can retail clinics be integrated into health care provider networks? and What sorts of chronic care services may be provided in the retail clinic setting?  There are some real synergies to explore.

For more posts on retail clinics and the saga of their entry into Massachusetts, see earlier retail clinics posts on HealthBlawg.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting