Rewarding Primary Care Providers for Excellence

In an ambitious effort to shore up U.S. primary-care medicine, a coalition including General Electric Co., International Business Machines Corp. and Verizon Communications Inc. is launching an initiative to pay doctors hefty bonuses for creating "medical homes" for patients.

So begins Vanessa Fuhrman's article in today's Wall Street Journal. The program she is speaking of is called Bridges to Excellence, a major mover when it comes to doling out financial incentives to doctors for increasing quality of care. Active in 18 states nationally, it paid out approximately $10 million in bonuses to doctors last year.

[...] doctors can receive $125 annual bonuses for each patient covered by a participating employer, up to a maximum $100,000 a year. Based on previous work with doctors' practices, Bridges to Excellence executives estimate such improvements in quality save $250 to $300 per patient in the first year.

"We know that in year one, the savings are there, so let's share half of that with physicians," says Francois de Brantes, the program's chief executive.

[...] It is also intended to help reverse the sustained decline of primary care in the U.S. Struggling against rising costs and a payment system that rewards procedure-based specialist care over spending time talking to patients and basic preventive medicine, family physicians and internists increasingly have had to squeeze in more patients for less pay.

In our current health care environment, as Mr. Halvorson points out in his book, there are over 900 billing codes for medical procedures and yet not one for a cure. Prevention simply is not as profitable. A financial incentive to doctors may be the shot in the arm our ailing system needs.

[...] the average American spends fewer than 30 minutes a year with a primary-care physician -- half as much time as patients in other developed nations -- a recent study in the British Medical Journal found. Doctors say that isn't nearly enough to head off preventable health problems or manage chronic illness.

"In order to fix this mess, we have to thoughtfully reshape the payment environment," says Bruce Bagley, medical director for quality improvement at the American Academy of Family Physicians. "Right now, we're getting exactly what we're paying for."

Since chronic illnesses account for roughly 75% of all health care expenditures, anything that helps shift the focus to preventative diagnosis and treatment has the potential for extensive long-term savings.

SOURCE: "Group Offers Doctors Bonuses for Better Care" 01/31/08

photo: screencapture of the Bridges to Excellence Website

Taking The Nation's Pulse With CodeBlueNow!

Kathleen O'Connor, the founder and CEO of CodeBlueNow!, is serious about health care reform. The consumer advocate is conducting a survey she calls the "CodeBlueNow! Pulse" that gathers people's attitudes about health care reform. You can take the survey online right now at the following link:

http://www.questionpro.com/akira/TakeSurvey?id=788175

The survey takes no more than 15 minutes to complete, your answers are confidential and your identity is not tracked.

Here's a 4-minute video from YouTube in which Ms. O'Connor explains the CodeBlueNow! Pulse? and the organization's mission:

O'Connor was a guest columnist in the Seattle Post-Intelligencer at the end of last week. She began by reminding us that the call for reform is not a new thing, citing the 1932 Report of the Committee on the Cost of Health Care. A wide variety of proposed solutions have failed over the intervening years.

The vision O'Connor presents has several important underpinnings, including universal coverage, emphasis on prevention, transparency within the industry about costs and benefits (especially in situations involving complex health decisions), and greater accountability in the health care industry.

Ms. O'Connor delivers a call to action for the voting public to become informed by facts rather than talking points and to take health care out of the hands of vested interests and politicians.

Our voice -- the public's voice -- hasn't been heard over the choruses profiting from the status quo. The complexity of our health care system is held up as a key reason the public cannot solve the problem -- "it's too complex."

But it's not. The complexity charge is an excuse to maintain the status quo, shouted by the foxes guarding the hen house.

More consensus exists than politicians and pundits lead us to believe. Our CodeBlueNow! Pulse® results from Iowa and Washington state (two very different states politically) clearly show there is astonishing agreement on some core values and key elements. We offer these visions and values as a starting point to create "The Voters' Health Care Platform." We must start with a vision and core values and build consensus along the way. This is a proven path to change with any social movement.

Yankee ingenuity, "can-do" attitude, spirit of innovation -- these are all iconic traits of the American culture. If we can harness those traits in the battle for health care reform, our odds of creating a uniquely American system of universal health care increase exponentially.

The CodeBlueNow! reports linked above show that a consensus at the public level is not lacking in this matter. I will continue to report as they gather and release more data.

SOURCE: "It's time to speak up on health care" 01/25/08
SOURCE: "CodeBlueNow!"

California Health Care: Bill's Co-Author Votes Against It

What a long, strange trip it's been for health care reform in California. After a yearlong effort ABX1-1, the health care bill backed by California Gov. Arnold Schwarzenegger and Assembly Speaker Fabian Núñez, has been voted down. The Senate Health Committee delivered a coup de grace in the form of a 7-1 vote against the measure, including a nay vote from Senate President Pro Tem Don Perata (D – Oakland) who originally co-authored the measure.

Rhonda Rundle at the Wall Street Journal talks about the factors that lead to this turnaround (page A9 if you prefer hardcopy):

Support began to erode in the senate as the outlines of the state's $14 billion budget deficit came into focus late last year.

Last week, the Legislature's nonpartisan fiscal analyst raised questions about funding for the package, further undermining its prospects. Lawmakers who had been leaning in favor of the negotiated bill began backing away in the face of uncertainty about how the state could enact an ambitious new program at a time of fiscal crisis when the governor has proposed cutting funds for established health-care programs.

ABC News 10, a California news station that covers Sacramento and the surrounding areas, brings us the view from the Chair as reported by Ayesha Thomas:

Committee Chair Shiela Kuehl said there isn't enough money to fund the program.

"There's insufficient funding there for so called subsidies, there's insufficient money there to cover the expanded Medi-Cal coverage," said Kuehl.

"If the headline is Health Committee kills reform, that's an erroneous headline. But we'll live with it...The right headline is Senate Health Committee does not pass bad bill," Kuehl added.

There's more where that came from. The News 10 article ends with a transcription of Gov. Schwarzenegger's Statement in response to the vote.

Since this is a California issue a visit to Brian Katz's blog is order. As usual Mr. Katz delivers the goods, this time in the form of this quote from Senator Perata explaining his decision:

In a letter to Governor Schwarzenegger and Speaker Nunez, Senator Perata wrote, “This bill – which is before the Senate, and the initiative, which is not – would create the third-largest program in state government, surpassed only by K-12 education and Medi-Cal. Under any circumstances, but especially in light of the state’s $14.5 billion budget shortfall, we have the fiduciary responsibility to approve a health care coverage plan that is both self financing and fiscally sound and a moral responsibility to protect from harm those who already have health care coverage.”

Mr. Katz provides our summation today, as he has stated it so eloquently.

The defeat of ABX1-1 is no cause for celebration. The reality is, while the health care system works well for many in the state, serious problems exist that need to be addressed. With the defeat of ABX1-1, pressure for change will continue to build. Lawmakers may succumb to the pressure to pass anything in order to have passed something.

SOURCE: "Health-Care Bill Fails to Pass" 01/29/08
SOURCE: "Key Committee Rejects Schwarzenegger's Health Reform Effort" 01/29/08
photo courtesy of d_vdm, used under this Creative Commons license

IADMD Offers Free Web Sites for Doctors & Dentists

According to a press release dated this morning, the International Association of Dental and Medical Disciplines (IADMD) is headed for the 33rd Yankee Dental Conference with some cutting edge plans. The medical professionals trade group is offering a new membership perk to those who join -- a professionally done, "upscale" website.

“A Web site is a like an office on the Internet and doctors should have flashy, professional and state-of-the-art Web sites,” says Dr. John J. Ryan, president of IADMD.

At the conference, the IADMD booth will be fully wired, so the various Web site design offerings IADMD offers can be displayed.

But it's more than just a giveaway. Connecting doctors of all disciplines to the Internet is the first step in an overall plan to reform the health care system so that doctors of all disciplines can communicate with one another and under one umbrella group.

The IADMD has an ambitious vision statement that embraces health care reform: "...to promote worldwide healing with a doctor-led, non-socialized plan, that does not add taxes or burdens on employers or individuals, and secures every person's right to the highest quality whole-body health care." Of particular note is the fact that IADMD websites will be e-commerce enabled, allowing patients to both pay online and order products from their doctors. The press release also touts the fact that a similar website would cost between five and ten thousand U.S. dollars, plus monthly hosting and administration fees.

The IADMD gets points for transparency. They are very straightforward about the fact that this is not only meant to be a necessary step forward technologically, but also a great way shine a spotlight on their own organization and efforts:

“If this sounds like a steal that’s because it is,” says Dr. Ryan. “People need to know that they are getting a bargain and we're doing it to get attention.”

The IADMD can be found at Booth #2812 and #2813 of the Yankee Dental Conference, January 30 - February 3 in Boston, Massachusetts. If any of our readers make it to the conference please stop by and share your thoughts about the IADMD initiative or other discoveries by posting a comment.

SOURCE: "New Doctor-led Health Care Reform Group All Smiles as it Heads to the Yankee Dental Conference" 01/28/08
SOURCE: "Yankee Dental Conference 33"

photo is a screencapture of the IADMD website's front page

Novello: An Inside View of Minority Healthcare

Uneven delivery of health care across the socioeconomic and ethnic spectrum is one of the major aspects of the crisis in health care that we face here in the United States. With that in mind, we are going to examine Dennis Taylor’s article in today’s issue of the The Monterey Herald, where he shares details from a lecture by Dr. Antonia Novello at the Monterey Conference Center:

The Puerto Rican-born physician offered the health care system of New York state — where she has been commissioner of health since 1999 — as an example of how to improve the system.

"People believe that socio-economic issues are the only things that trigger disparities in health care in our country, but it has been found that it is much more than that," said Novello, who became the first woman and first Latina to serve as U.S. Surgeon General during the administration of President George H.W. Bush. "The factors include poverty, lack of good health insurance, lack of good health care, distrust of the system."

Cultural and communication problems are a big part of the problem, she said. […]

Another perception, she said, is that private patients get seen by attending physicians, while the poor get seen by medical students or residents.

"Sometimes those students are tremendously sharp," she said. "The problem is that a patient rarely is seen by the same student at the next appointment."

Poverty is another concern, the doctor said, when exorbitant percentages of a person's income go to necessities such as rent, food, child care and transportation.
"Every time you have to make a decision, you have to ask yourself, 'Where do I invest my money?' Sometimes it's not that we don't want to (seek medical help); it's that we can't because our money is positioned to serve certain necessities."

Novello stressed that health care professionals must take time to inform people of the avenues that are available to them, because "information is power," she said.

Information is, indeed, key. People need to have access to accurate data in order to make informed decisions about their health care. You cannot choose if you don’t know the options available. You cannot choose if communication with your provider is obscure or unclear. You cannot choose if there is no adequate way of comparing the performance of potential providers.
Information, data portability, transparency, and common provider numbers are all extremely important steps on the road to universal health care.

SOURCE: " Improving minority health care " 01/25/08
photo courtesy of akeg, used under this Creative Commons license

Electronic Medical Records: Up East & Abroad

With so much health care news these days mired in the politics of the various U.S. Presidential primaries and caucuses, I believe it's time to take a glance at some pertinent info that is getting lost in the shuffle. The topic I would like to put a spotlight on today is EMRs, Electronic Medical Records.

Let's start with this morning's Boston Globe, where Milton J. Valencia describes the creation of a new community-based network of physicians in the South Shore area of Boston, Massachusetts, who focus on sharing medical databases and records, Brockton Hospital's new Signature Healthcare:

Under the network, doctors will work off one system, making services more cost efficient, Goodman said. Standards of care will be the same within the network; all doctors will use the same prescription drug formula, for example, so that patients with the same illness aren't prescribed different drugs - saving the hospital money in buying the drugs, Goodman said.

This implementation of standards marks an important point in the evolution of health care procedures. The implementation of standards and measurements (systems thinking) is one of the big concepts in Mr. Halvorson's book, and this looks like it could be a fine step forward in that regard. The Globe's article continues:

The most evident change will be shared electronic medical record keeping, which has become the latest tool allowing doctors to share information with specialists and a key element in building a network of providers, said Rich Copp, spokesman for the Massachusetts Hospital Association.

"It's an example of hospitals around the Commonwealth doing what they can to integrate their care," Copp said. "Being able to have one system . . . is really going to be a great convenience and help improve the quality of care in Brockton."

Alan Wechsler of the Albany Times Union writes about a landmark grant program geared toward defraying the cost of implementing EMRs for small practices that would otherwise be hard pressed to afford them. The interesting part is that the grants are coming from the Capital District Physicians' Health Plan:

The Albany-based health insurer plans to award a total of $1 million, piece by piece, to small practices in the Capital Region for the purpose of investing in electronic medical records technology. [...]

The medical records system is expected to bring better health care by preventing duplication and dangerous drug interactions, as well as giving doctors access to better information about their patients. In the long term, it's expected to decrease the cost of health care -- something of great interest to insurance companies.

Lastly comes this article by Kelly Kennedy from the Air Force Times website which brings us positive tidings from overseas:

After decades of doctors treating brain injuries, heart problems and complex war wounds at Landstuhl Army Medical Center in Germany, hospital administrators there have also belatedly leaped the technological divide to create electronic records.

CliniComp International has been awarded a contract to create and track electronic medical records at the Defense Department’s largest hospital outside the continental U.S. The company provides the service for 18 other military hospitals, which together comprise 45 percent of inpatient beds in the military system.

All in all there seems to be quite a bit of good news on the topic of EMRs. Let us hope that the trend continues.

SOURCE: "Health network to keep care close to home" 01/24/08
SOURCE: " Insurer an ally in data upgrades" 01/23/08
SOURCE: "Landstuhl to use electronic medical records" 01/23/08
photo courtesy of John A. Ward, used under this Creative Commons license

ECHCI: Analyzing European Health Care Systems

Jane Sarasohn-Kahn at Health Populi once again delivers the goods as she examines the latest version of the Euro-Canadian Health Care Index (ECHCI) and its findings on the subject of consumer-centric health care systems:

The concept of consumerism in health care has migrated to Europe. The Health Consumer Powerhouse, a self-described "do-tank" (as opposed to "think-tank") based in Brussels and Stockholm, innovated and perennially updates the ECHCI. This year, the Powerhouse has added sister-nation Canada to the mix, and the results are fascinating. A key objective for the Index is to promote transparency across health systems in Europe; transparency is a major initiative in the European Union.

The Powerhouse points out that the top 5 countries all have "Bismarckian" health systems; that is, they were founded on the principles of social insurance where many health plans compete in markets and are also independent of the delivery system. This is in marked contrast to a system such as the UK's National Health Service, founded on "Beveridge" principles where financing and delivery are organized within one system (that would include Canada).

She correctly observes that a large amount of context is required to properly interpret the indexes, Still, it's useful to deconstruct them in order to gain insights into our current situation.

The Index is calculated using a "pentathalon" of five measurements: Patient rights and information, treatment waiting times, outcomes, generosity, and pharmaceuticals. These metrics lead directly to Ms. Sarasohn-Kahn's "Hot Points:"

When I ponder the five components of the ECHCI's pentathlon of consumer-friendly measures, the one that is most surprising from the US perspective is "generosity." I peeked under the hood of generosity and found the following metrics: cataract operations per 100,000 citizens; infant disease vaccination rates; kidney donations per million people; and, dental care as part of the public health offerings.

What is consumer-centrism in American health care? Is it "generosity?" To a colleague with whom I met yesterday, consumer-centrism was being seen on-time at a physician appointment. To me at my daughter's last visit to her pediatrician, it was spending sufficient time discussing the health challenges of a tween girl in 2008. When it's about you, the consumer, it's the micro-details of your experience with health providers, payors, products.

I heartily advise reading her complete post; it offers a number of useful insights into new ways of looking at health care delivery here in the U.S. In Health Care Reform Now!, George Halvorson stresses that we should look to other existing systems for ideas while crafting a health care model that is unique to our nation. Every industrialized nation has found a path to universal coverage. The U.S. must do the same, but along that path we can find elements of the systems in use elsewhere that can either be integrated into our approach or inspire new approaches.

SOURCE: " Consumers and health care through the Euro-lens" 01/23/08
photo courtesy of Albertane, used under this Creative Commons license

Wal-Mart Makes Health Care Announcement

In an announcement today Wal-Mart Stores, Inc. stated that it has experienced a drop of more than 20 percent in uninsured employees over the past year.

Businessweek gives us a breakdown:

The world's largest retailer said only 7.3 percent of its workers reported being uninsured, down from 9.6 percent the year before. Wal-Mart, which union groups have targeted over health care, said more than half of its eligible employees received coverage under its health care plans, a first in recent reporting. [...]

Linda Dillman, an executive vice president of benefits and risk management for Wal-Mart, told reporters on a conference call Tuesday that the increased enrollment likely came from the company's new health care plan. The plan, which allows employees to customize their coverage, includes premiums as low as $5 a month and access to $4 prescription drugs.

"Everybody in this company is on the same set of plans," Dillman said. Wal-Mart president and CEO "Lee Scott made the same selection the newest part-time cashier at Wal-Mart did."

According to the interview, 50.2 percent of employees made use of the company's health care plan this year, an increase from 47 percent last year (46 percent in 2006, and 43 percent in 2005). The increase is attributed to positive changes made in Wal-Mart's health plan, changes which include lowered premiums and copays for Prescription drug, coverage for the children of part time workers and a shortened eligibility period.

State lawmakers have criticized Wal-Mart for allowing its workers to take part of state-funded health care for the poor. A confidential 2006 state study in Washington state showed Wal-Mart had 3,194 workers on Medicaid and the state's Basic Health Plan, more than any other private employer.

Dillman said the retailer had seen a slight drop-off in the number of employees saying they took part in state-sponsored health care coverage, but said the percentages stayed roughly the same.

"We did get some movement off of the plan, but we didn't see much change in terms of the total percentage," Dillman said.

As of this time Meghan Scott, a spokeswoman for WakeUpWalMart.com, a union-backed website critical of the company's shortcomings on this issue declined to comment.



SOURCE: "Wal-Mart says more workers insured" 01/2/08

photo courtesy of Code Poet, used under this Creative Commons license

Health Care in Maine: Net Gains

The State of Maine is poised and ready for February 1, 2008. On that date the state's health care leaders will begin an ambitious and exciting project: the development of one of the United State's first statewide "health information exchange." Non-profit venture HealthInfoNet, the group spearheading the effort, has retained 3M and Orion Health to assist on the technology end of the equation.
Bernie Monegain, editor of Healthcare IT News, brings us a synopsis of the plan:

"This project will be big and far-reaching - touching the lives of more than half of Maine's population," said David Howes, MD, vice chairman of HealthInfoNet and president and CEO of Martin's Point Health Care.

Wendy Wolf, MD, president and CEO of the Maine Health Access Foundation, said she and her colleagues view HealthInfoNet as a key way to provide better care for both insured and uninsured patients in the state. Uninsured patients tend to receive the least coordinated care, she noted.

[...]

Beginning this winter, more than 2,000 healthcare providers, including 15 rural and urban hospitals across Maine and one-third of practicing physicians in Maine, will join with the Maine Center for Disease Control and Prevention (part of the Department of Health and Human Services) in a 24-month pilot of the new network.

Monegain says that once the network is launched across the state, network officials project an approximate $50 million reduction in healthcare costs due to the reduction in unneeded and duplicate testing, procedures, and hospital admissions.

HealthInfoNet makes possible a consolidated electronic health record that combines data usually kept in separate physical locations such as labs, private health care providers, hospitals, etc. As the program develops it should also provide individuals with a much greater level of access to their own personal health records.

SOURCE: "Maine begins to build statewide HIE" 01/16/08
photo courtesy of tanakawho, used under this Creative Commons license

Alegent, MEDSEEK Team Up to Empower The Patient

On January 15-16 decision makers from nine U.S. health care systems met with analysts, technology experts and policy makers in Omaha, Nebraska for Alegent Health's "Power to the Patient," forum. This event is geared toward the development of policies and systems that provide tools and information to consumers in the interest of allowing them to make more informed decisions on health care issues.

The Alegent Health Online Press Room lists the confirmed participants as:

• Aurora Health Care, Milwaukee, WI


• Elliot Health System, Manchester, NH


• Martin Memorial Health Systems, Stuart, FL


• Mercy Medical Center, Cedar Rapids, IA


• North Shore LIJ Health System, New York, NY


• Provena Health System, Joliet, IL


• Sisters of Mercy Health System, St. Louis, MO


• St. John’s Health System, Springfield, IL


• Via Christi Health System, Wichita, KS

According to the press release from MEDSEEK, who are supporting the forum, Alegent will share its proprietary technology and methodology with any health system that sent a representative to the forum. According to Alegent CEO Wayne Sensor, this could be a large step forward in data transparency, electronic medical records, and the application of systems thinking to health care:

"Information technology is at the core of our ability to better serve consumers," noted Sensor. "Whether it’s providing patients accurate pricing and quality information through the Internet, or implementing greater use of it in our practice settings, our experiences in putting information technology to work for the benefit of consumers is something we are eager to share openly. That is what the 'Power to the Patient' forum is about -- helping other health care providers to learn from our mistakes and benefit from our experiences."

The website for "Power to the Patient" lists the objectives of the forum as follows:

• To foster acceptance of transparency among health care providers, resulting in an environment that empowers consumers to make quality health care decisions by the use of meaningful tools and information.
• To help providers begin or progress along their journey to cost and quality transparency by sharing experiences about innovative new access points and the implementation of consumer-driven health plans within the workforce.
• To create an environment where the lessons and ideas of providers in this arena can be shared and discussed.

Alegent is a faith-based health care system with nine hospitals in Nebraska and Iowa. MEDSEEK is an Enterprise eHealth solutions provider focused on connecting information and people in order to provide better care and promote community advocacy.

SOURCE: "Press Release: National Policy Makers and Health Care Executives Come Together to Discuss the Future of Health Care" 01/15/08
SOURCE: "Alegent: Power to the Patient"
SOURCE: "Press Release: Alegent Health Establishes "Power to the Patient" Forum to Focus on Increasing Consumers’ Engagement in Health Care"
photo courtesy of neovain, used under this Creative Commons license

Hurry Up and Wait: Emergency Care in The US

"I mean, people have access to health care in America. After all, you just go to an emergency room. "
- President George W. Bush Cleveland, OH July 7, 2007

This morning a Harvard study was released that is causing ripples across the media and Internet. Let us begin with the The Boston Globe's medical column:

Between 1997 and 2004, wait times went up an average of 4.1 percent per year for all patients, but for heart attack patients, the waits stretched 11.2 percent per year, researchers from Cambridge Health Alliance report in today’s issue of Health Affairs. Blacks, Hispanics, women, and patients in urban hospitals waited longer than other patients.

"The striking finding is that waits are increasing for all Americans, for people who are insured and for people who are uninsured," lead author Dr. Andrew Wilper, also a fellow in internal medicine at Harvard Medical School, said in an interview. “For patients with severe illnesses, it is troublesome.”

The Houston Chronicle converts those percentages into minutes and also provides this telling quote from Charles Begley, a professor at the University of Texas School of Public Health:

"Because the emergency room has become a source of primary care for a lot of people, it is distracting the emergency room from being able to provide the emergency trauma care that the community needs," Begley said.

For patients across the country identified as needing "emergent" care, wait times increased to 14 minutes in 2004, up from 10 minutes in 1997, study authors reported. And the subset of patients who were diagnosed as suffering from heart attacks saw a significant increase, from eight minutes in 1997 to 20 minutes in 2004.

A twenty minute wait time for a heart attack victim? Think about that for a moment. Think about how long a minute is when suffering chest pains.

The Washington Post also has a piece online today which tells us a bit more about how the data was compiled :

The researchers analyzed data on patient visits and wait times collected between 1997 and 2000, and from 2003 and 2004, by the National Hospital Ambulatory Medical Care Survey, a nationally representative database. Among other findings, they learned that wait times tended to be longer for African Americans and Hispanics, perhaps because those patients are often treated in urban emergency departments, which are more likely to be overcrowded than their rural counterparts.

In recent years, several expert reports have detailed the strains on emergency room care in the United States. Three reports issued in 2006 by the Institute of Medicine, a branch of the National Academies, concluded that the nation's emergency medical system is "overburdened, underfunded and highly fragmented."

It is well documented (in Health Care Reform Now! of course) that for chronic conditions such as asthma, a few hundred dollars a year are required to manage the condition, while a single emergency room visit could skyrocket to over $20,000. This cost factor combined with the wait times present a disturbing portrait of a broken system.


SOURCE: "Emergency room wait times getting longer" 01/15/08
SOURCE: "Wait times at the ER are ticking upward: Researchers say patient care is at risk as crowding causes many to just leave" 01/15/08
SOURCE: "Emergency Care Waits Found to Be on Rise" 01/15/08
photo courtesy of macoggins, used under this Creative Commons license

California Nurses Use Obama's Words Against Schwarzenegger Plan

This morning The Nation brings us some interesting news (via Yahoo). Evidently while U.S. Senator Barack Obama is focusing his attentions on other states, his voice is ringing out across California thanks to an ad campaign run by the California Nurses Association (CNA). The ads attack the health care reform plan backed by California Governor Arnold Schwarzenegger, Democratic Assembly Speaker Fabian Nunez, and a group of major insurance corporations.

The radio ads being aired by CNA announce that, "The nurses of California agree with Senator Barack Obama: the government shouldn't punish people who can't afford health insurance."

Then an audio clip from Obama is heard. "I know that there have been some folks who said that it's not possible to provide universal health care coverage unless there's a mandate," says the senator. "Their essential argument is the only way to get everybody covered is if the government forces you to buy health insurance. If you don't buy it, then you'll be penalized in some way. And the reason people don't have health insurance is because they can't afford it."

You may read a transcript of the ad or listen to/download it in MP3 format from the CNA Online Press Release.

The CNA has not gone easy on Senator Obama's plan in the past. Last year the organization's then president, Deborah Berger, RN, criticized it for failing to address pricing practices in the health care industry. She said that those practices, "put so many American families at financial and health risk."

Then there is Iowa. During the recent caucuses the CNA ran an ad aimed at Senator Obama which said: "It's not good enough just to be better than the Republicans on this."

The current ad campaign has potential to be a very powerful one. Senator Obama's voice and face have become ubiquitous, especially after his victory in the Iowa caucuses. The CNA, as we wrote about here, was the group behind the last month's powerful "if he were anyone else, he'd be dead by now," ad campaign that used U.S. Vice-President Dick Cheney's recent medical history as it's basis.

It will be interesting to see what direction things take in response, especially between now and the California presidential primary on February 5.

SOURCE: " Putting Obama to Work for Health-Care Reform" 01/11/08
SOURCE: "Nurses Unveil New Advertising Campaign Against Schwarzenegger-Nunez “Individual Mandate” Plan" 01/10/08
photo courtesy of Transplanted Mountaineer, used under this Creative Commons license

San Francisco Health Insurance Mandate gets Green Light from 9th Circuit Court

The Ninth Circuit Court of Appeals is allowing the City of San Francisco to move forward with its new health care plan despite the recent ruling of the U.S. Federal District Court. A few weeks ago Judge Jeffrey White ruled that the funding component of the plan violated The Employee Retirement Income Security Act of 1974 (ERISA)

Bob Egelko at the San Francisco Chronicle offers a simple summation in his analysis of the situation:

That provision requires large and medium-size companies to offer insurance to their employees or pay a fee to the city for the cost of their coverage. The court said the city probably would win its argument that U.S. District Judge Jeffrey White was wrong when he ruled Dec. 26 that local governments lack the power to force employers to contribute to a health care program. [...]

The law was challenged by the Golden Gate Restaurant Association, which represents more than 900 Bay Area establishments. Dan Scherotter, the association's incoming president, said the restaurants were disappointed but would comply with the ruling and remained confident of winning after the court hears all the evidence.

Avoidable suffering was cited by Judge Williams Fletcher as a reason for the 3-0 decision. According to Egelko's article the case has been prioritized and final written arguments are due this April with a possible decision this year.

For more detail on this topic I would advise reading the primer on the case posted yesterday on the Alan Katz Health Care Reform Blog. As usual Mr. Katz included a number of useful sources including a link to the actual court decision and some thoughts concerning the ramifications of this decision for California's proposed statewide health care plan (ABX1-1).

ABX1-1 and its companion ballot initiative create a similar funding mechanism at the state level. Opponents of the legislation claim it, too, violates ERISA. This decision undermines the argument of those critics.

Or as Speaker Nunez put it in a statement issued by his office today, in what can be considered the political equivalent of a running back's victory dance in the end zone, "Opponents of health care reform now have one less rubber arrow in their quiver as they try to stop our historic effort to fix the broken system and make health care more affordable and accessible to the people of California."

Only time will tell what impact the precedents set in this case will have on the reform of health care across the nation. One thing is certain: no matter what the final decision is, it will have a far-reaching ripple effect.

SOURCE: "Ninth Circuit Allows SF Health Plan to Go Forward" 01/09/08
SOURCE: "Appeals court allows S.F. to enforce health care law" 10/10/08
photo courtesy of tinkerroll21, used under this Creative Commons license

On The Road With Robert Reich

Today our media offering is from The Wall Street Journal. This morning in their commentary section we find Robert B. Reich, professor of public policy at the University of California at Berkeley and former U.S. Secretary of Labor under President Clinton, sharing his views on "The Road to Universal Coverage."

He begins by noting that on the Democratic side of the current race for the White House all three major candidates (Senators Clinton, Obama, and Edwards) have made health insurance issues a major part of their individual platforms. He also notes the despite overwhelming similarities in their plans they are focusing on the small differences in the battle for their party's nomination. "Mandates are a sideshow, and fighting over them risks turning away voters from the main event."

After a lucid and concise comparison of the plans presented by Democratic frontrunners, in which he demonstrates just how similar they are, he continues:

This fight is little more than a distraction, given that a mandate would matter only to a tiny portion of Americans. All major Democratic candidates and virtually all experts agree that the combination of purchasing pools, subsidies, easy enrollment and mandatory coverage of children will cover a large majority of those who currently lack insurance -- even without a mandate that adults purchase it. A big chunk of the remainder are undocumented immigrants, who aren't covered by any of the plans.

Should the remaining 3% of the population be required to purchase insurance, or lured into it by rate decreases and subsidies? Reich's position is that the answer depends on who you think comprises that 3%.

Comparing Senators Clinton and Obama he shows us the difference in views on this topic. Senator Clinton's position is that the 3% are youthful and in good health, which means they would lower the overall cost of health care as their payments subsidize others. Senator Obama's position is that many of them simply cannot afford coverage even with subsidized premiums. His belief is that they would either ignore the mandate or simply be unable to afford it. To Mr. Reich's credit his conclusion after comparing them is cautious and well reasoned. Like much of the current discussion on the topic it also casts an eye towards Massachusetts:

Who's correct? It's hard to know. So far, the Massachusetts experiment suggests Mr. Obama. Massachusetts is the only state to require that every resident purchase health insurance. The penalty for failing to do so could reach $4,000 next year, but the state has already exempted almost 20% of its current uninsured from the requirement. Massachusetts is concerned they can't afford a policy, even with subsidies similar to those in all the Democratic plans. So far, about 50% of Massachusetts's uninsured have complied with the mandate.

He closes with a call to action for Democrats, encouraging them to "stop leading with their chins," in counterproductive arguments over mandates and begin building momentum for large scale and desperately needed change. Change that they all already agree upon.

SOURCE: "The Road to Universal Coverage" 01/09/08
photo courtesy of Kevin Dooley, used under this Creative Commons license

The Two Trillion Dollar Health Care Bill

The nation's health care bill for 2006 has just been released in the current issue of Health Affairs. While the rate of growth has slowed the total still comes to a record high of $2.1 trillion dollars!

According to analysts, medical expenditures increased 6.7% in 2006 -- slightly higher than the 6.5% increase in 2005 and double the rate of inflation. The increase in health care spending has been as much as four times the inflation rate in recent years.

Prescription drug sales climbed more than average, jumping $16 billion in 2006, 8.5% higher than in 2005. Approximately half of that increase is due to the Medicare Part D prescription drug plan, which covers many people who had no prior prescription coverage.

NPR's Joanne Silberner addresses the ramifications in her report on Morning Edition today (which you can listen to online):

Health care consultant Bob Lasziewski says it's like a ship sinking at a reduced rate from how it was sinking before. "Health care is still increasing at twice the rate of inflation," he says. "Five years ago, it was four times the rate of inflation."

But twice the rate of inflation is still unsustainable, he says, especially given what he sees for the future: doctors and hospitals joining together to resist insurers' cost cutting, and baby boomers continuing to age.

Paul Ginsburg, president of the Center for Studying Health Systems Change, warns that if an economic downturn occurs the cost of health care will take an even larger portion of paychecks as wages decline. In addition he sees the national obesity epidemic and changes in the health care marketplace as worrisome issues that could exacerbate the situation further.

The increase in prescription drug spending was part of an overall increase of $62 billion in Medicare expenditures, which topped $400 billion in 2006, up a staggering 18.7% from 2005. Steven Reinberg of U.S. News and World Report examines the situation:

Dr. Sidney M. Wolfe, director of the Health Research Group of Public Citizen, said he thinks the significant increase in expenditures in the Medicare drug program was due to the law that prohibits the government from negotiating prices with the drug companies, as well as a great deal of waste in administering the program.

"If you have a segment of health care completely out of control as in prescription drug prices for Medicare -- it's a strong argument why there should have been price controls and negotiated prices," Wolfe said.

In 2006, the U.S. population reached 300 million people. With medical spending at $2.1 trillion, that's $7000 for every man, woman, child, and undocumented worker in the country.

The burden of over 50 million uninsured Americans is distributed largely to insured Americans through higher insurance bills, higher medical bills, and higher taxes. When the cost of the uninsured is added, the average cost for insured Americans is $8500. Medical spending per insured American now averages $25,000 a year for a family of three. Clearly something needs to be done to restrain the growth in those numbers and/or get better care for such substantial outlays.

SOURCE: "Nation's Health Care Bill Hits All-Time High" 01/08/08
SOURCE: "Medicare Drug Plan Fuels Health-Care Spending: But Medicaid spending slowed for first time since its inception in 1965 " 01/08/08
SOURCE: "National Health Spending In 2006: A Year Of Change For Prescription Drugs " Jan/Feb Issue, 2008
photo courtesy of AMagill, used under this Creative Commons license

Electronic Medical Records: The $77 Billion Solution

Reform of the American health care system is a huge part of the current political discourse. A major aspect of that reform as proposed by George Halvorson in his book Health Care Reform Now! is widespread adoption of Electronic Medical Records (EMR's or EHR's).

EMRs are making news on both the east coast and west coast this week. On the east coast Senator Hillary Clinton pressed for EMRs in response to a question from the crowd in a New Hampshire appearance.

C|net news blogger Anne Broache provides a sound bite from Sen. Clinton's comments:

"We go online to buy things from Mongolia, we go online to do our banking, but we can't go online in a secure, encrypted, confidential way to get access to our medical records," she lamented.

Diana Manos, Senior Editor of Healthcare IT News also covers the story:

The adoption of EHRs [electronic health records] is not new to Clinton, who has included them as a kingpin to her presidential healthcare platform from the start. Gearing up for New Hampshire's primary next Tuesday, Clinton told voters that moving to electronic records from paper could save an estimated $77 billion in healthcare costs.

Last May at George Washington University, Clinton said that moving healthcare from paper to electronic records is among several key ways the country could cut runaway healthcare spending by one third.

The other side of the U.S. brings more news about EMRs. Reuters offers a press release about Cisco Systems joining the effort to create the country's largest health information exchange service:

"Cisco recognized early on the importance of transforming the health care
system through electronic health records and information sharing," said Nick
Augustinos, Cisco Internet Business Solutions Group Director. "Through
collaboration with CalRHIO and other technology leaders, we believe California
will lead the nation in creating a statewide health information exchange
system that not only supports clinicians, but also helps consumers make better
health care choices."

Cisco partners with HP, Perot Systems Corporation, and Medicity, Inc. as partners in this effort. The final objective is to enable EMRs to be shared in a confidential manner among health care providers across the state of California as well as through the National Health Information Network (which is currently under development).

Before EMRs grabbed the attention of the U.S. Presidential contenders, healthcare delivery systems were already moving toward shared electronic records. Prompted by individual states or by financial self-interest, health care providers and employers have decided not to wait for federal legislation. Now that the politicians are climbing on board, it's hard to imagine a future that does not include easy access to medical records over the Internet.

SOURCE: "Clinton presses for electronic medical records" 01/04/08
SOURCE: "Clinton: Time to digitize all Americans' medical records" 01/04/08
SOURCE: "Cisco Joins CalRHIO Effort to Build Country's Largest Statewide Health Information..." 01/07/08
photo courtesy of Kevin Zollman, used under this Creative Commons license

New Year's Health Care Reform Roundup

Welcome to our first health care news roundup of 2008! Most of the health care news lately has been about the politics of reform. From mandates in Massachusetts to the floor of the California State Capitol there is no lack of news on the subject. With that in mind we would like to share a small sampling of health care in the media as we end the first week of the New Year.

Lets start in Iowa, the land of the caucus. CNN brings us text and video about Kathy Strangli, an Iowa voter who is dying of an incurable lung disease called lymphangioleiomyomatosis. She is devoting her final days to changing U.S. health care and has been grilling candidates on the subject across the state of Iowa to do it. So far she has confronted all but two presidential hopefuls on the subject and has attended more than 70 campaign events to do so.
[Story] [Video]

Next stop is California, a state that has held a high profile in the news as Governor Schwarzenegger and the state legislature have wrestled with implementing universal healthcare. Aliza Marcus over at Bloomberg takes a good hard look at Schwarzenegger's battle for health care reform and the lessons it holds for U.S. Presidential candidates.
[Story]

Then we turn our attention to the East Coast of the U.S. The Business Review brings us the scoop on New York Governor Eliot Spitzer's decree to his Health Commissioner and his Insurance Superintendent that they have until May 31 to concoct a plan for universal coverage in New York state.
[Story]

As we move along the coast we find the Boston Globe reporting on Vermont Governor Jim Douglas who is aiming his efforts at preventative medicine. To be specific he is attacking obesity, a major contributor to "more than 15 chronic conditions." The details will be released during his State of the State address next week, but the Globe article gives a basic overview of the plan (adding prevention specialists, allocation of grant money, among other features).
[Story]

Our last stop on this virtual tour is in New Hampshire, the next state to fall under the media microscope now that the Iowa caucuses are finished. As the various contenders for the White House prepare to converge on the state the International Association of Dental and Medical Disciplines (IADMD) has issued a press release calling on the candidates to get input from actual doctors when formulating their approaches to health care reform.

"Health care is such an important issue the candidates should be listening to the IADMD doctors that have the medical training to solve the crisis. I commend Hillary Clinton, John Edwards, Mitt Romney and Barack Obama for talking about health care. But their plans are not viable for many reasons, such as cost and their non-doctor approach," says Dr. Ryan.

Dr. John J. Ryan is the founder of the IADMD and a New Hampshire based family dentist.
[Press Release]

That's all for now, see you next week!

SOURCE: "Schwarzenegger's Health Battle Carries Warning for Candidates " 01/04/08
SOURCE: "Businesses warm to idea of universal health care" 01/04/08
SOURCE: "Governor wants to fight obesity with grants and specialists" 01/03/08
SOURCE: " Dying Iowa voter grills candidates on health care" 01/03/08
SOURCE: "Press Release: New Hampshire Doctors Group Challenges Presidential Candidates on Universal Health Care" 01/04/08

photo courtesy of Benimoto, used under this Creative Commons license

Kaiser Releases Summary of Candidates' Positions on Health Care

It is the third day of the New Year, and tonight the Iowa Caucasus will determine the shape of the upcoming run for President of the United States. Facts, fiction, and anecdote swirl together in a dizzying fashion as all of the hopefuls make one final push for the hearts and minds, or at least the votes, of the Iowa public.

What exactly, you may ask, is a caucus and why is it so important in the run for the White House? Mark Z. Barabak of the Los Angeles Times explains the process and its history in an article this morning.

No matter what part of the political spectrum you embrace one thing is sure: this year's Presidential race is going to be a doozy! This is good news in at least one respect because it means a lot more public debate about our broken health care system, which is consistently listed as one of the most important issues to American voters.

Whether you are in Iowa debating who will receive your vote tonight, New Hampshire where the next fight in this running political battle will be, or anywhere else in the U.S. you will need facts and details in order to properly formulate your decision.

On the subject of health care reform, at least, you have a wonderful resource available in the Kaiser Family Foundation's breakdown on what the candidates and the media are saying about health care. Released on January 2nd, the Kaiser Health Policy Report gathers together in one place the pertinent media coverage, recent developments, polls, broadcast coverage, and opinion pieces concerning the U.S. Presidential candidates' positions on health care reform. The data is summarized, documented, and linked for ease of use.

SOURCE: " Election 2008 | Presidential Candidates Debate Health Care Proposals in Preparation for Iowa Caucuses " 01/02/08
SOURCE: "Why Iowa? And what's a caucus, anyway?" 01/03/08
photo courtesy of John Edwards 2008, used and remixed under this Creative Commons license

Massachusetts Uninsured Penalty to Quadruple

I would like to start off today by wishing all of our readers a healthy and happy New Year from all of us on the Health Care Reform Now Blog Team! May 2008 be a fantastic year for all, and hopefully a year in which we will see substantive strides toward health care reform in the United States.

To kick off 2008 I would like to direct your attention to the Boston Globe's Jefffrey Krasner, who has his eye on Massachusetts.

2008 will be an important year for the state's health care reforms, which were signed into law by U.S. Presidential hopeful Mitt Romney during his term as Governor of Massachusetts in 2006. The maximum penalties for remaining uninsured will increase nearly four fold to almost a thousand dollars a year. The cap for 2007 was $219 and was implemented as a forfeiture of the individual's tax exemption, not a fine.

Mr. Krasner provides a nice breakdown of how the penalty fee structure is supposed to work. The amount of the penalty is directly tied to the lowest cost insurance option using a formula determined by the state's Department of Revenue:

Under the formula issued yesterday, the amount an uninsured resident pays for 2008 varies by income and how long the resident goes without insurance. For instance, those 26 and younger that earn too much to qualify for low-cost insurance and who go the whole year without coverage would pay a $672 penalty. Those 27 and older would pay $912, the maximum. Those who have coverage for part of the year would pay a corresponding amount of the penalty.

In addition, those who earn less than 150 percent of the federal poverty level, or $15,324 for an individual won't face penalty.

The fees are based on half the cost of the least expensive insurance plan available to each resident but are capped to avoid excessive fees. Thus, a 60-year-old resident of Boston, who would pay more than $4,600 a year for health insurance provided by the state, could have been hit with a $2,300 penalty. But the maximum possible penalty is $912 for all residents. The draft regulations are available at the revenue department's website at mass.gov/dor.

There is no accurate estimate of how many Massachusetts residents will have to pay the penalty for 2007 yet, due to the fact that the penalty is tied to individual tax returns which are not due for several months.

This will be the crucible in which the mandate approach is tested, and I am certain that as the U.S. Presidential campaign ramps up many eyes will be on the Massachusetts plan. Mandates have been a central part of the political discussions on health care, with Democratic Presidential hopeful Barrack Obama being the only member of his party not proposing one.

SOURCE: "Penalties to rise for shunning insurance: State healthcare levy could exceed $900" 01/01/08
SOURCE: "Massachusetts Dept. of Revenue"
photo courtesy of koalie, used under this Creative Commons license