The Health Care Blog

Creative thinking about the CER agenda

By JOSHUA SEIDMAN

This week the Institute of Medicine (IOM) released its list of the top 100 topics that should be addressed in  comparative effectiveness research (CER) now — thanks to $1.1 billion in the American Recovery & Reinvestment Act — that the federal government actually has the resources to do substantial CER. IOM has prioritized the list by creating four quartiles, noting that the first quartile is the highest priority group, etc.

In order for the federal government to make good use of the huge pot of CER money, there are at least five things that they need to do to ensure its value and actually change care delivery. I’m all for trying to find out whether me-too drugs add any significant value. However, the greatest opportunities for implementing delivery system change that improves care effectiveness and efficiency relate to innovations in how care is organized and delivered, and how insights are communicated to the broad range of health care actors — most notably consumers.

That’s why I was heartened by the IOM’s top 100 list — though certainly I’d move a few up a quartile or two. The list has many projects that fit my priorities, including a strong emphasis on CER to reduce health disparities.

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HELP! This is Unbelievable

By ROGER COLLIER

Key members of the Senate Health, Education, Labor, and Pensions Committee announced on Thursday what they claimed were dramatically improved cost and coverage estimates for the latest version of their health care reform bill.

Headed by Democratic Senator Christopher Dodd, HELP members (in a Muzak-marred conference call with reporters) stated that the revised bill would cost only $611 billion over ten years, a figure apparently computed by the CBO, and that with a further expansion of Medicaid would provide coverage for 97 percent of Americans.

Key features of the bill provided during the conference call included a public plan option, subsidies for lower-income individuals buying insurance through an exchange mechanism, and a play-or-pay employer mandate.

Sounds good? We’ll have to wait for details, but two big problems are already apparent.

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Commentology

Futurist Jeff Goldsmith's analysis of issues that could cause problems for any health reform effort that eventually emerges from the foodfight in Washington this summer provoked a wide range of reader replies.   ("No Country For Old Men")  Goldsmith wrote in response:  

The fun part of this blog is how much you learn about an issue when you post something.  Several learning points: 1) How big a deal this is.  $1.6 trillion sounds like a lot of money, but over ten years, it's less than 1% of the cumulative GDP over those ten years (which I grew to $16.8 trillion from its present $14t in 2019).  In other words, it's peanuts.   Cumulative health spending over this time looks like over $40 trillion, so  even $600 billion in Medicare cuts looks like peanuts.   These are small numbers made to look big because of the ten years.  Plus ten year numbers are BS anyway because you never get a linear increase over that type of time span.  $1.6 trillion actually sounds like  Dr. Evil's ransom demands in Austin Powers. . .

THCB Reader Margalit offered this response to Dr. Rick Weinhaus's open letter to former Harvard professor Dr. David Blumenthal, the man charged with masterminding the Obama administration's ambitious health IT push ("An Open Letter to Dr. David Blumenthal"), urging the administration to rethink support for the current EMR certification process ... 

"Maybe Dr. Blumenthal should come up with two separate "certification" suggestions similar to the auto industry.

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Is Wal-Mart Leading the Charge on Health Reform?

By RAHUL PARIKH

Last Wednesday's  headline in the Wall Street Journal may have surprised you.  It read:  "Wal-Mart Backs Drive to Make Companies Pay for Health Coverage."  The article discussed Wal-Mart's open support for an employer mandate requiring all but small businesses to provide care for its workers, a stance that other retailers have opposed for obvious reasons.  

I've been following the story of Wal-Mart and health care reform for the past several years.  While some see this move as the company's way of trying to level the playing field between it and other retailers, it nevertheless has taken several actions over the past decade to make health care more accessible and affordable. 

Wal-Mart's transformation began in 2006, when then CEO Lee Scott shook hands with Andy Stern, the head of the Service Employees International Union. In the past, such a handshake would have been unimaginable.  Wal-Mart had earned a reputation for failing to provide its workers with health care, and the SEIU was one its strongest critics. 

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Biggest and best month ever on THCB

By Matthew Holt

By the time most of you read this, I’ll be heading to England to tell those Limeys how to do healthcare right the American way….or something like that, and then off to China. I’ll be back in Freedonia in about 10 days

But I’d be remiss if I didn’t mention the stellar month we’ve had at THCB. Apart from last October when the election and Google brought lots of people to THCB (particularly to one excellent article by Bob Laszewski on Obama's health plan) this has been by far our most heavily trafficked month. We’ll end up somewhere around 85,000 visits and 135,000 page views. And the quality of the writing in posts from Jeff Goldsmith, David Kibbe and Brian Klepper, Roger Collier, Michael Millenson, Susannah Fox and many many more, has been excellent. In addition we've had lots of controversy notably in Daniel Gilden's fascinating piece on McAllen and Grand Junction that's been read and commented on by lots of very very astute people. Then there’s been the campaigns like HealthDataRights.org, and lots of fun back and forth in many many comments.

So many thanks to THCB editor-in-chief John Irvine & associate editor Ian Kibbe for keeping the wheels turning, to all our contributors, to our sponsors/advertisers who enable us to keep the lights on, and of course to all of you for coming and reading and having your say! -- Matthew Holt / THCB Publisher

Careful What You Wish For

By THE INCIDENTAL ECONOMIST

On the left are those who would like health reform to include a strong public plan, one that could negotiate large provider discounts, driving down the cost of medical care. On the right are those who think health insurance should be provided only privately. I’m neither left nor right. I consider myself a realist and an empiricist.

A reasonable reading of the political tea leaves suggests that health insurance for the non-elderly will remain largely a private affair. (See the Debating the Public Option in The American Prospect by Paul Starr, Robert Reich, and Robert Kuttner.) Therefore, I’d like the private insurance market to work well. I’m also very familiar with the Medicare experience (and its problems) with both public and private provision of insurance.

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Implementing a Modern Hospital Website

By JOHN HALAMKA

Over the past two years, I've witnessed a transition in modern website design from plain text and static  information to multimedia centric and interactive. I've written about the new BIDMC website we implemented to meet patient expectations for a modern website.

Many healthcare organizations I work with are considering content managed, new media, highly interactive web 2.0 sites. I thought it would be useful to describe how we approached the BIDMC website so you can leverage our experience.

Content Management - BIDMC has a great deal of .NET expertise, so we wanted a content management system that worked well in our .NET/SQL Server 2008 environment. SiteCore has been ideal for us, providing content templates, distributed content management, and publishing workflow in a load balanced, secure, virtualized environment. At HMS we use Drupal and Wordpress for content management. They also work well for hosting institutional web sites.

Interactive features - The Corporate Communications folks at BIDMC really wanted to highly improves interactivity. We built and bought the components they needed as follows

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The Myth of Prevention and EHR’s?

By SCOTT SHREEVE

I was just referred this article which I found to be thoughtfully crafted. Abraham Verghese is a Professor and Senior Associate Chair for the Theory and Practice of Medicine at Stanford University. I found the article interesting, by somewhat anachronistic in terms of his perception of prevention and electronic medical records.

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Rantology: Cannon on Freedom or Power?

By Matthew Holt

Ah-ha. Michael Cannon has now replied to me and it basically comes down in his mind to me being a  crypto-fascist Stalinist wanting to break the will of the American people mediated through its representatives, the health care industry lobbyists. His piece is The Ultimate Question: Freedom or Power?

He closes by saying that I could only fix the health care system by getting rid of constitutional democracy. And Michael’s right.

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No Country for Old Men

By JEFF GOLDSMITH

As we enter summer, the health reform process is moving into its Newtonian phase: irresistible forces meeting immovable objects.   In both health cost and access, the trend is not our friend.  There is ample evidence not only of intolerable inequities, but also intolerable waste and inappropriate use of expensive clinical tools.  President Obama embodies the need for change. He has assembled a very talented and politically savvy crew of helpers.  He confronts the sternest test of any Presidency, fixing a poorly tuned and fragmented health system that is, by itself, larger than either the French or British economy. 

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THCB UPDATE

If you haven't had a chance to sign up for THCB UPDATE yet, you really should. You'll get a helpful reminder email from us when important posts go up on the site.

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Unions May Get a Pass on Health Care Benefits Tax

By ROBERT LAWSZEWSKI

There is a major bipartisan effort going on in the Senate Finance Committee to reform the health care system.

Reportedly, one of the elements of that effort may be a tax on "gold plated" health insurance benefits above a certain threshold--$17,000 for family coverage is one option being discussed. The new tax could raise close to $300 billion over ten years to help pay for a health care bill.

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Health 2.0 NYC Chapter Meetup, July 9th

Once again we are looking forward to an exciting and packed event on July 9th. So RSVP early and please make it firm.  Before we get to the agenda, I urge everyone to explore and endorse "A Declaration of Health Data Rights."

Presenters:
1. HandHold Adaptive, LLC, Dan Tedesco -  Dan will present iPrompts - the portable, customizable, visual prompting tool for those with special needs.

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The Message Is The Medium

By MERRILL GOOZNER

Emory University psychologist and political consultant Drew Westen in the weekend Washington Post offers a troubling view of the public's role in health care reform. While reform's reality involves complicated technical issues like insurance exchanges, public plan governance, physician and hospital payments and who will pay higher taxes, the public's understanding of these issues is virtually non-existent, Westen assumes.

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A little more on insurers, and reform means more of the same

By Matthew Holt

In the comments on my piece on Michael Cannon (which Michael has not commented on sadly, as I was  hoping for a nice fight! Michael has replied here and I'll reply back on Monday), everyone’s favorite insurance broker Nate asked me to describe a bit more the process of a small group buying health insurance. I’m not quite ready to do that yet, but instead I will point you towards this piece I wrote about buying individual insurance in 2006. It’s called A Tale of Two Underwriters and it explains how screwed up the process is.

If you want more, here’s some nitty gritty on the actual process of dealing with eHealthInsurance.com the largest online broker which—for those of you interested in small group insurance—told me last year is encouraging employers to give their employees a lump sum and kick them into the individual market. And I guess for those healthy employees that’s good news, and if you're not.....

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And in reply to the ABC Obamamercial...

By Matthew Holt

Stephen Colbert’s Republican Health Care Infomercial. Quite wonderful. Can’t get it to embed but here’s the link

A Costly Wrinkle in the Merged Market

By CHARLIE BAKER

One of the more controversial elements of health care reform in Massachusetts is the so-called “merged market.”  In most states, individual health insurance is bought and sold under one set of rules, and small group insurance (for firms with either 1-50 employees or 2-50 employees) is sold under another set of rules.

It used to be that way in Massachusetts, too, before health care reform. 

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An Open Letter to Dr. David Blumenthal

By RICK WEINHAUS, MD

Below is a slightly expanded version of a letter I recently sent to Dr. Blumenthal, the new National Coordinator for Health Information Technology, and the members of the new national HIT Policy Committee.

Dear Dr. Blumenthal:

I am writing to you on the need for user-friendly electronic health record (EHR) software programs.  As a practicing physician with first-hand experience with hard-to-use CCHIT-certified EHR software, I would like to share with you a solution to this vital issue.

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The EHR TimeBar: A New Visual Interface Design

By RICK WEINHAUS, MD

The EHR TimeBar functions as a high-level overview of the patient record, as a query device, and as an intuitive navigation tool.  Each EHR file (event) for the patient is represented by an icon. The set of icons and their labels are displayed in column format on the right side of the screen.

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Data to the People

By GREGORY PARK

I have been a strong proponent of the creation of a National Health Record (NHR), but will it increase the quality of care for each citizen? Without 100 percent compliance by all healthcare providers the establishment of the NHR will bear little fruit for its expense.
Proponents of a NHR site the achievements of the VHA. VHA patients include highly mobile active and inactive soldiers. Ubiquitous methods for viewing clinical data are critical, however Joe Outpatient doesn’t move around in this manner nor does he stray far from the facilities where he receives care.

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Commentology: National Health Information Networks; What is the Benefit?

Gregory Park from DB Technology, wrote in to say this about National Health Information Networks:

"I was wondering where is the debate on the real benefits in NHINs.  What is the benefit exactly?  The way that I see it, most of the benefits could be achieved by lower tech efforts such as disease hotlines which exist today.

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Health Wonk Review: Confederations Cup Edition

Up at the Healthcare Economist. Daniel Gilden's piece over here leads off, as it should!