Electronic Health Records: Should Congress “Defund” the Stampede to Convert to EHRs? No, But . . .

Health care information technology [HIT] “is not ready” warns Dr. Scot Silverstein, a clinical IT expert on the faculty at Drexel University’s College of Information Science and Technology. Writing on Roy Poses’ Health Care Renewal at the end of last week, Silverstein argued that Health IT “is dangerous in unqualified hands, which most every medical center and physician office is in 2011 (i.e., an IT backwater).

“The field of health IT [has] somehow [been] transformed from an experimental field into the 'savior of medicine’” Silverstein added, “without the proof of value and safety that would ordinarily be required to move an experimental technology from lab to national rollout. Per the Washington Post, this process appears to have been a highly politicized one, favoring the corporate elites. The Washington Post’s 2009 article on the influential HIT vendor lobby ‘The Machinery behind Healthcare Reform’ is at this link.”

Set Silverstein’s words side by side with what software expert Dan Fornes had to say on The Health Care Blog yesterday, where he reported that vendors selling health care software are “spending like crazy,” and a larger picture begins to emerge.

Is Achieving Mental Health Parity a Pipe Dream?

The Mental Health Parity and Addiction Equity Act passed by Congress in 2008 was hailed as “a milestone in the quest for civil rights, an effort to end insurance discrimination and to reduce the stigma of mental illness.”

This law, which finally took effect in July 2010, prohibits large group insurance plans from placing coverage or treatment limits on mental health and substance abuse services that are more restrictive than those imposed on medical and surgical services. The Parity Act also prevents these plans from requiring patients to pay a larger share of mental health charges in terms of deductibles and co-payments. When the legislation first passed, federal officials predicted that some 113 million Americans would have better access to behavioral health services—82 million of those through their employer health plans.

Under the Patient Protection and Affordable Health Care Act, mental health parity is now set to be extended to millions more Americans. Most significantly, all insurance plans sold on the state exchanges in 2014—available to individuals and smaller companies with fewer than 50 employees who were exempt from the 2008 Parity Act—will have to offer coverage for mental health services that is on par with medical and surgical services. Some of the 32 million currently uninsured people who will newly qualify for Medicaid benefits will also have mental health parity—but only if they are enrolled in managed care plans.

A Nurse Faces Her Diagnosis: Incurable Cancer

Amy Berman tells her story here, on the Health Care Blog. http://www.thehealthcareblog.com/the_health_care_blog/2011/01/can-good-care-produce-bad-health.html#comments

Her courage and eloquence are remarkable. Facing death, she is able to express her concern for other patients. 

If you or anyone you know is struggling with cancer, you might find this post helpful.

No, You Do Not Have the Right to Free Emergency Care

Below, a guest post by Harold Pollack, who has recently joined The Century Foundation as an adjunct fellow focusing on issues of Economics and Inequaiity.  Pollack is the Helen Ross Professor at the School of Social Service Administration, and faculty chair of the Center for Health Administration Studies at the University of Chicago .--MM

During the health reform debate, many people asserted that the uninsured are, de facto, already covered because they can always get emergency care. Here, for example, was President George W. Bush in 2008: I mean, people have access to health care in America," he said. "After all, you just go to an emergency room."

Thursday, one of Ezra Klein's commenters says something similar, though from a different locale on the ideological spectrum:

If the Republican Party is serious about decreasing government control of health care, they should start by introducing a bill that would repeal the law signed by President Ronald Reagan that mandates free health care for all who seek it. That law, the Emergency Medical Treatment and Labor Act (EMTALA), was the largest expansion of government mandated health care since Medicare.

For obvious reasons, it would be terrible health policy to make emergency departments into our all-purpose free-care safety-net, even in a hypothetical universe where these facilities were actually capable of providing all the care that people need. But that's not what EMTALA actually does.

Community Clinics as An Alternative to the ER?

I may be more optimistic than Harold Pollack that the Affordable Care Act (ACA) will reduce ER use (see Pollack's guest post). After all, the ACA provides an additional $11 billion in funding for Federally Qualified Health Centers (a.k.a. “community clinics.”) Many are open after hours, and as existing community clinics are expanded and new ones are built, they could serve as medical homes for patients who now get their care at their local emergency room. This year alone, the ACA will provide a 50 percent increase in federal support for these clinics where patients can receive less expensive, preventive and primary care. (It’s worth noting that the government has already begun to distribute this money; this is just one example of many programs that cannot be “de-funded.”) The legislation also permanently authorizes the community health center program, which once had to be reauthorized every five years.

HHS: Anti-Fraud Investigations Reap Financial Rewards

The government recaptured a record $4 billion last year from pharmaceutical companies, hospitals, doctors, nursing homes and other providers that defrauded federal health-care programs, the administration reported Monday. This is twice as much as was recouped in 2008, and funneled some $2.9 billion back into the Medicare Trust Fund.

This is a good start—Medicare and Medicaid fraud reportedly cost the government a whopping $54 billion last year—but we can do even better. In a new report from the Department of Health and Human Services and the Department of Justice, the success in recouping fraudulent payments is attributed to the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint effort between the two agencies created in 2009.

Earlier this week, new federal rules came into effect that HHS Secretary Kathleen Sebelius says will allow the government to be more proactive in preventing fraud in the Medicare, Medicaid and CHIP programs. These new rules (click here to see an overview) which are included in the Affordable Care Act,  require more rigorous screenings of providers and suppliers who participate in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP), levy larger fines for abuses, and also give HHS the power to immediately stop payment to providers who are being investigated for fraud. The goal of these new provisions is to prevent fraud rather than playing catch-up once the crimes have been committed.

State of the Union: Why the President Said So Little about Health Care

In his State of the Union speech, President Obama devoted only a few minutes to health care reform. This might surprise some, but I think the president made a wise decision. There was little reason for him to spend more time on the issue. The Patient Protection and Affordable Care Act (PPACA) is  now the law of the land. There is no reason for the President of the United States to debate it.

President Obama did allow that “anything that can be improved in the legislation” should be changed. I agree. As the law is implemented, experience will show us where adjustments should be made. 

Extending a hand across the aisle, the President also said that “we can start now by reducing unnecessary bookkeeping burdens on small businesses,” referring to the provision  in the heallth care reform legislation which requires that every business provide a 1099 for each vendor with whom it does more than $600 worth of business over the course of a year. This was a provision tacked onto the heath care bill, designed to reduce tax fraud. I applaud the motive, but when it comes to reforming health care, this is not an important plank in the legislation.

More importantly, President Obama made it clear that he would not bow to any effort to undermine the individual mandate: “What I am not willing  to do,” he declared, “Is to go back to the days when insurance companies could deny patients because of pre-existing conditions."

President Obama is confident about the Affordable Care Act because he knows that, this year, health care reform already has begun to deliver benefis to a great many Americans:

--- Small business owners are taking advantage of the tax credit and signing up for insurance for their employees

The Predicament of Backache

Below, a guest-post by Dr. Nortin Hadler, author of Worried Sick: A Prescription for Health in an Overtreated America and , more recently, Stabbed in the Back: Confronting  Back Pain in an Overtreated Society. I admire both books because they are so well-written and richly referenced..

Hadler is Professor of Medicine and Microbiology/Immunology at the University of North Carolina at Chapel Hill and Attending Rheumatologist at the University of North Carolina Hospitals.

 

His commentary on “The Predicament of Backache” is adapted from, Stabbed in the Back. It  puts my posts on spinal surgery in a larger context, illustrating how “cutting” is not always a cure for life’s problems                     

 

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To live a year without a backache is abnormal.  Here, I am speaking of the commonest form of low back pain: the backache that bedevils working-age adults who are otherwise totally well. This is a pain that does not involve the legs, and that comes on suddenly, seemingly without cause.

Low back pain is one of many recurring predicaments of life, like heartburn and heartache. To be well is not to be spared. To be well is to have the wherewithal to cope till the pain goes away, cope so well that the episode is not even memorable.

A Surgeon Stands Up To His Peers, and Fights for the Physician Payment Sunshine Act -- (Part 2 of “On the Road to Reform”)

 
Summary: In part 1 of this post I discussed how the mainstream media has begun the work of health care reform by making the public aware of the amount of waste and hype in the system. There, I focused on two recent stories about back surgery: the first appeared in the Wall Street Journal, the second on Bloomberg. Both tell the tale of patients injured and billions of health care dollars squandered when patients suffering from back pain caused by “degenerative” (aging) spinal discs undergo a very pricey procedure called “spinal fusion.” 

As I explain in part 1, medical research shows that when back pain is caused by aging discs, fusion is not as effective as other, less lucrative, treatments. And, with fusion, the rate of serious complications is much higher. Nevertheless, from 2002 to 2008, the number of fusions done in U.S. hospitals doubled to 413,000, generating $34 billion in health care bills. In 2008, Medicare alone laid out $2.24 billion for the procedure.

Meanwhile both Bloomberg and the WSJ reported that device-makers such as Medtronic, which makes products used in spinal fusion, have been handing out millions in royalties and “consulting fees” to surgeons who promote the procedure. Congressional critics charge that in many cases, these payments are nothing more than “kickbacks."

A Round-up of the Best of Health Care Bloggery

This week, Managed Care Matter’s Joe Paduda hosted Honk Wonk Review’s  regular summary of particularly provocative health care  posts that appeared in the past two weeks.  As always, Paduda’s insights make the Review well worth reading.  (I also recommend Managed Care Matters as a blog where you’ll find very smart, objective, fact-based commentary on a wide variety of issues.)

Below, I comment on some of the posts in this week’s Review, but to read the entire round-up (and to find links to posts I mention below)  please click here.  http://www.joepaduda.com/archives/002013.html

Perhaps the most intriguing post in this week’s round-up comes from HealthCare Renewal’s Roy Poses. An M.D., Poses also has become a relentless investigative reporter, and in this piece he discusses “the fall of an apparently large and prestigious health care charity, which funded research projects at the most well-regarded academic centers - a charity that was involved with Bernie Madoff and some of his confederates.”

If you read Poses’ post (and I urge you to do so) you’ll discover that the charity in question--the Picower Foundation--was not quite what it seemed.

In 2008, Poses observes, both the Boston Globe and the New York Times lamented the fact that the Picower Foundation, which had become one of “Maddoff’s victims” was shutting down. Apparently their reporters hadn’t Goggled “Picower.”  Poses calls attention to a more recent Wall Street Journal piece that raises some troubling questions. 

Poses then takes us back to a 2001 St Petersburg Times expose of the Picower Foundation “which suggests that its Jeffrey Picower used it in a complex scheme involving self-dealing for the purposes of personal enrichment.” 

He ends his tale by asking: “The big question is why people can be so easily fooled?