6 points with regard to regulatory threats and mobile health IT

Not long ago, the American Enterprise Institute (AEI) hosted an event titled, "There's a medical app for that – or not: Regulatory threats to mobile health information technologies." It was an extension of a recent Wall Street Journal article, focusing on the FDA, medical apps and the future of mobile health IT.

"All eyes are on the Supreme Court – everyone's starting at the Supreme Court, but that's not the only healthcare news in town," said J.D. Kleinke, resident fellow at AEI and healthcare business strategist. "An attempt has been made by the FDA to expand its mission to one of the more dynamic and important issues happening in healthcare and that's health IT generally, but more specifically, mobile applications."

"For the most part, health IT is a politically neutral zone," he continued. "People from the right and the left agree a computerized healthcare system makes more sense. It's a bipartisan idea, whose time has not just come but is long overdue."

Kleinke and Joel White, executive director of the Health IT Now Coalition, outline five points to consider with regard to regulatory threats to mobile health IT.

1. The FDA has taken an interest in mobile apps. In July of last year, the FDA issued its Draft Guidance on mobile medical applications. "So increasingly, we're seeing that in the market place, as more consumers become comfortable with IT and doctors use apps to treat patients, the FDA is looking at these technologies and have been for some time," said White. "IT is rapidly advancing, and they had to think about the advancements and how that'd fit into a regulatory framework." Essentially, he said, the Draft Guidance for mobile apps does a couple things. For instance, it makes it so apps fall under FDA regulatory authority as medical devices and would be classifies as Class One, Class Two, and so forth, based on what the app does in conjunction with diagnosing the patient. "It would have to go through the regulatory structure for approval," said White. "And if [the app] isn't considered a mobile device, it wouldn't have to go through this process."

2. Issues arise with mobile apps and the 510(k) process. Devices are now classified under the same risk structure as the 510(k) process, which "isn't known as a rapid process," said White. "If you think about the life cycle of apps and software, generally, it is very rapid. So that change in the actual app may trigger some change in the regulatory structure if they go through the 510(k) process." He added that although the FDA does have an "appropriate role to play" in ensuring the safety and effectiveness of these apps, according to the IOM, the 510(k) process has significant issues, most notably, the length of time to get approval. "Most poignantly, the IOM said last year in a report, that the process wasn't working well for the industry or for patients," he said. "So clearly, the process has some challenges."

3. Risk factors do exist when it comes to mobile apps. An IOM report, which was released last November, did confirm three serious issues that exist with regard to mobile apps. "A panel of experts looked at issues of health IT and patient safety, and they concluded serious risk factors," said White. "Errors with how IT operates, errors with how physicians use IT, and information asymmetry issues, or information about a patient or care treatment protocol that wasn't available when using the technology in ways it was intended." What IOM concluded, he said, was there wasn't coordination across agencies, where these issues touch base in jurisdictions. "None of the agencies have resources at their disposal in terms of expertise to address some of the follow-ups in regard to patient safety."

Continued on the next page.

In this week’s Health Wonk Review:

The June 22 edition of Health Wonk Review is posted now at Managed Care Matters, and�features columns from healthinsurance.org bloggers Maggie Mahar, Harold Pollack, and Henry J. Aaron.

They discuss the pending Supreme Court decision on the constitutionality of the Affordable Care Act and its individual mandate, the 2012 elections and what both will mean to the health reform law.

Health Wonk Review is a biweekly compendium of the best of the health policy blogs. More than two dozen health policy, infrastructure, insurance, technology, and managed care bloggers participate by contributing their best recent blog postings to a roving digest, with each issue hosted at a different participant's blog.

ONC targets Rx drug abuse with new data initiative

WASHINGTON – The Office of the National Coordinator for Health IT has launched a pilot program to make existing prescription drug use data available to healthcare providers and pharmacists when they treat patients during office visits and in emergency departments.

The test projects in Indiana and Ohio will measure the effectiveness of expanding and improving access to prescription drug monitoring programs (PDMPs) as part of the administration’s efforts to reduce prescription drug abuse.

The monitoring programs are statewide electronic databases, which are designed as a tool for providers to identify and intervene in cases of potential prescription drug abuse. The databases collect, monitor and analyze electronically transmitted prescribing and dispensing data submitted by pharmacies and dispensing practitioners.

The idea is that by improving real-time access to the information it will encourage providers to use the program more than it is now. So far, 49 states have legislation authorizing prescription drug monitoring programs or have active programs.

“The PDMP pilot projects will help hospital staff identify a patient’s controlled substance history at the point of care to enable better targeting of appropriate treatments and reduce the potential of an overdose or even death,” said Farzad Mostashari, MD, national coordinator for health IT. “We are not creating new systems; we are adding value to those that exist,” he added.

In Indiana, emergency department staff will be able to receive a patient’s controlled substance prescription history directly through the Regenstrief Medical Record System (RMRS), a care management system used by Wishard Health Services, a community health system in Indianapolis, and other hospitals.

The project is a collaboration of ONC, Regenstrief, Wishard, the National Association of Boards of Pharmacy, Appriss Inc., and the State of Indiana. In some states, Emergency departments are responsible for almost 25 percent of all controlled substance prescriptions.

The Ohio pilot will test having a drug risk indicator in the electronic health record (EHR) and how that affects clinical decision making. The Ohio project is a collaboration with the Springfield Center for Family Medicine, Eagle Software Corporation’s NARxCHECK, the State of Ohio, and MITRE.

The hope is that the pilots will improve real-time data sharing among providers, increase interoperability of data among states, and expand the number of people using these tools, according to Gil Kerlikowske, director of National Drug Control Policy.

The Enhancing Access to PDMPs Project stems from joint efforts of public sector and private industry experts that participated in the White House Roundtable on Health IT and Prescription Drug Abuse last year and the subsequent action plan (PDF).

The Centers for Disease Control and Prevention has said that the United States is in the midst of an epidemic of prescription drug overdose deaths, which outnumber deaths from heroin and cocaine combined.

AHIP Gave More Than $100 Million to Chamber’s Efforts to Derail Health Care Reform

The nation’s leading health insurance industry group gave more than $100 million to help fuel the U.S. Chamber of Commerce’s 2009 and 2010 efforts to defeat President Obama’s signature health care reform law, National Journal’s Influence Alley has learned.

During the final push to kill the bill before its March 2010 passage, America’s Health Insurance Plans gave the chamber $16.2 million. With the $86.2 million the insurers funneled to the business lobbying powerhouse in 2009, AHIP sent the chamber a total of $102.4 million during the health care reform debate, a number that has not been reported before now.

The backchannel spending allowed insurers to publicly stake out a pro-reform position while privately funding the leading anti-reform lobbying group in Washington. The chamber spent tens of millions of dollars bankrolling efforts to kill health care reform.

The behind-the-scenes transfers were particularly hard to track because the law does not require groups to publicly disclose where they are sending the money or who they are receiving it from.

For example, in its 2009 IRS filing, AHIP reported giving almost $87 million to unnamed advocacy organizations for “grassroots outreach, education and mobilization, print, online, and broadcast advertising and coalition building efforts” on health care reform. That same year, the chamber reported receiving $86.2 million from an undisclosed group. Bloomberg’s Drew Armstrong first reported the AHIP-chamber link. The $86 million accounted for about 42 percent of the total contributions and grants the chamber received.

The next year followed a similar pattern. In 2010, AHIP reported giving $16.5 million to unnamed advocacy organizations working on health care reform and the chamber reported receiving about $16.2 million from an undisclosed source, which the Alley has learned was AHIP. The $16.2 million accounted for about 8.6 percent of the total contributions and grants the chamber received that year.

Chamber spokeswoman Blair Latoff would not provide the providence of the $16.2 million donation saying only, “We filed our tax returns for calendar year 2010 in November. Schedule B lists all of our contributions, one of which is $16 million dollars from one entity.”

AHIP spokesman Robert Zirkelbach was similarly vague. He referred the Alley to a statement the group put out in 2010 when AHIP’s $86 million transfer to the chamber was first reported.

“We, like other major stakeholders, invested in advocacy. We supported a number of leading health care advocacy organizations and coalitions that shared our views,” the statement said. “While the new law helps millions of people obtain coverage, it fails to bend the health care cost curve. Health plans are committed to working on ways to make coverage more affordable and minimize disruptions for those who are currently insured.”

An AHIP official did say the $16.5 million spent in 2010 was on advocacy efforts prior to health care reform’s passage and had nothing to do with political spending ahead of the 2010 midterm elections.

The news that insurers gave more than $100 million to help fuel the chamber’s efforts to derail health care reform comes as the nation girds for a Supreme Court decision this month that is sure to reignite the health care reform debate on Capitol Hill and the campaign trail.

Elahe Izadi contributed.

Obama sets up formal office for healthcare reform

WASHINGTON (Reuters) – President Barack Obama set up an executive office for healthcare reform at the White House on Wednesday, saying the overhaul was one of the biggest priorities for the first year of his presidency.

Obama issued an executive order that says the U.S. healthcare system “suffers from serious and pervasive problems.”

The White House Office of Health Reform (Health Reform Office) will help the executive branch steer “the federal government’s comprehensive effort to improve access to health care, the quality of such care, and the sustainability of the health care system,” the order reads.

It also says the Secretary of Health and Human Services will create an Office of Health Reform to work with the White House office.

Obama has nominated former Clinton administration health official Nancy-Ann DeParle to lead the White House office. His nominee for Health and Human Services secretary is Kansas Governor Kathleen Sebelius.

The new office will help ensure that policymakers across the executive branch work toward Obama’s healthcare agenda, the order reads.

U.S. government economists predict that public and private health spending will hit $2.5 trillion this year, taking up a 17.6 percent share of gross domestic product.

Yet studies suggest Americans get poorer care than people in other industrialized countries that have national healthcare plans, and 46 million Americans have no health insurance at all.

HHS announces $25M in funding for Aging and Disability Resource Centers

WASHINGTON – Health and Human Services Secretary Kathleen Sebelius on Thursday announced $25 million in funding to enable states to expand their ability to help seniors and people with disabilities access home and community-based long-term support.

Over the next one to three years, the funding, made possible by the Affordable Care Act, will support technology-enabled Aging and Disability Resource Centers (ADRCs) in nearly every state.?

Each year, more seniors, people with disabilities and their families are confronted with often challenging decisions about how to obtain the long-term services and support they need. Choices range from care in their home to care in a nursing home, social supports for daily living and transportation to physical therapy.

Sebelius says ADRCs will make it easier for people to learn about and access the services that are available in their communities and best meet their needs.

“We are pleased to make it easier for Americans to get the care and support they need where they need it,” she said. “This opportunity, supported by the new healthcare law, will help states continue to improve their long-term service and support systems.”

The initiative, known as the Aging and Disability Resource Center Program, is established through a partnership between the Administration for Community Living (ACL), the Centers for Medicare & Medicaid Services (CMS) and the Department of Veterans Affairs’ Veterans Health Administration (VHA).

The VHA will make an additional $27 million available over three years in ADRC-funded states through the VA Medical Centers. This funding will increase access to home and community-based services, some enabled by mobile and telehealth technologies, for veterans through ADRC programs.?

"Veterans with disabilities are increasingly looking for services that help them remain in their own homes with their loved ones," said VA Under Secretary for Health Robert A. Petzel. "Today's announcement offers one more opportunity for VA to continue to thank our Veterans by providing them support in a setting of their choice, in this case their own home."

The ADRC Program will help state agencies administer and better coordinate state and federal long-term service and support programs for older adults, people with disabilities, and veterans with disabilities, officials say. Approximately eight states will be competitively selected to accelerate the development over a three-year period of the creation of single entry point models, which provide one-on-one options counseling to streamline the intake and eligibility determination processes for consumers accessing long-term service and support programs.

“Options counseling is an important tool that can provide custom-tailored advice about all the services available in a person’s community, reducing unnecessary time and energy spent searching for answers in a variety of places," said Kathy Greenlee, ACL’s administrator and assistant secretary for aging.

[See also: Home telemonitoring works, study claims.]

“We want these programs to serve as high-performing ‘one-stop shop’ models across the country,” added CMS’ Acting Administrator Marilyn Tavenner.

In addition to accelerating activities in the eight states selected, funding will be provided by ACL to up to 40 states next year to support their current ADRC programs, officials say. This will help them develop a sustainable infrastructure that's critical to ensuring ongoing coordinated access to services.

Ashley-Care: Health Care Coverage Without Stress for a Young Adult

Today, 3.1 million people are newly insured thanks to a provision in the law that enables young adults to stay on their parents� health care plans. Ashley Drew is one of them. Ashley, a young woman from Scarborough, Maine, was born with Cystic Fibrosis, a life-threatening chronic disease. She spends a lot of time in hospitals getting special IV antibiotics, respiratory therapy and physical therapy to clear her lungs and fight infections. One month in the intensive care unit cost her about $144,000; her last stay was for three months.

Ashley was diagnosed with end-stage lung disease and waited on two transplant lists for more than 500 days. She recently successfully underwent a double lung transplant.

Because of the health care law, the Affordable Care Act, young adults under the age of 26 may be able to stay on their parents� health insurance, and for Ashley, this has made all the difference. Staying on her parents� insurance allowed her to pursue her education to become a music teacher and to study instrumental conducting � at a pace she could handle with her health condition � and not worry about how to make sure she had coverage.�

�The fact that the Affordable Care Act is in effect, it�s amazing, because it�s horrible to have to worry and stress about your health and, in my case, something that everyone takes for granted: breathing,� Ashley says. �Everyone deserves to breathe, but unfortunately without health insurance that�s not a reality for some people.�

Without the security that staying on her parents� insurance plan provides, Ashley says she would be spending all her time trying to figure out how to come up with the money for her treatment.

Ashley believes the benefits under the law are important for people who don�t have her immediate health concerns as well. �I think the Affordable Care Act brings peace of mind to people all over this country because you don�t know when something�s going to happen,� she says. �Just to know that you have health insurance � You�re not going to lose your car and you�re not going to end up homeless because you got sick.�

BancTec acquires GTESS claims processing business

IRVING, TX – BancTec, which specializes in financial business process outsourcing, transaction automation and document management, has acquired certain assets of Richardson, Texas-based GTESS, a provider of claims pre-adjudication technology and services for the healthcare industry.

GTESS has served a client base including more than 40 healthcare payers nationwide. BancTec officials say the acquisition – financial terms of which were not disclosed – will enable the firm to strengthen and expand its healthcare claims processing services.

“In this era of healthcare consolidation and reform, health plans and related organizations are under increasing pressure to improve efficiency – but too often are held back by complex, manual pre-adjudication processes,” said Maria L. Allen, senior vice president and president of the Americas at BancTec. “With this addition, BancTec will be able to effectively address this pain point as part of an integrated claims processing offering.”

Founded in 1990, GTESS specializes in automation technologies that drive cost and process improvements in the front-end, or pre-adjudication, portion of healthcare claims processing. This includes the automation of costly, labor-intensive pre-adjudication processes such as provider and member matching and paper claim handling, keying and processing. GTESS has enabled clients to achieve their goals for increased automation, speed and lower costs of claims processing.

“BancTec and GTESS have shared a commitment to superior service and client satisfaction that have stood the test of time,” said Mark King, chairman of GTESS.  “Like GTESS, BancTec provides flexible, focused automation and outsourcing solutions that serve the healthcare industry well. This strategic move gives clients the opportunity to significantly reduce annual expenses by lowering the cost per claim and dramatically improving accuracy, consistency and customer response.”

Dartmouth Board garners $26M innovation grant

With a $26 million government Health Care Innovation Award in hand, the Dartmouth Board of Trustees will  hire Patient Family Activators (PFAs), who will assume roles of patient advocate, assisting the patient with care choices and engaging them in a shared decision-making process.

The project will support and connect 15 High Value Healthcare Collaborative (HVHC) member healthcare systems throughout 16 states, and over the course of three years, will train 5,775 healthcare workers and create 48 new PFA positions.

A portion of the funding will also be used to improve patient data collection via health information technology, as William Weeks, MD, co-creator of the Dartmouth Institute for Health Policy and Clinical Practice, explained.

“Some funds will be used to both facilitate learning and deployment across the HVHC members as well as collecting data (through grant funded tablets that will be integrated into local EHRs), feeding back reports on results, and expanding current IT infrastructure to supplement current HVHC reporting abilities and better integrate such reporting into HVHC member IT systems.”

Health and Human Services (HHS) Secretary Kathleen Sebelius announced on June 15 the second round of recipients for the Health Care Innovation Awards, funded through the Affordable Care Act. The  Dartmouth Board of Trustees was among 81 groups nationwide that walked away with a win.

Three-year cost savings from the Dartmouth project are estimated to be more than $63.7 million, and Weeks explained the majority of savings would result from the overall reduction in Medicare costs of each patient.

Weeks said, “Savings are therefore derived from both improving the efficiency and reducing the costs of each episode of care and using patient shared decision making to help patients make informed decisions, decisions which – according to the literature – are more conservative and less costly than the care that their providers would recommend.”

He continued, “By engaging providers in improving the efficiency and safety of care processes, and by engaging patients in the decision-making process regarding their healthcare choices, we believe that we can reduce this variation and waste, reduce the unrestrained growth in healthcare costs, and concurrently improve patient satisfaction and health outcomes.”

The Dartmouth Board of Trustees-sponsored program was one of 107 total projects nationwide that garnered an Innovation Award out of more than 3,000 applicants nationwide.

The Centers for Medicare & Medicaid Services (CMS) created the Center for Medicare & Medicaid Innovation to improve the health of Medicaid, Medicare and CHIP patients - and by extension all Americans - while combating escalating costs. The $1 Billion Health Care Innovation - carries a triple aim: better health, better healthcare and reduced costs. The Innovation Challenge provides three-year grants of $1 million to $30 million to healthcare providers, payers, local government entities, and public-private partnerships, including collaborative efforts among multiple payers.
 

Technology at forefront of NHS treatment in Scotland

EDINBURGH – Online scanning to allow remote diagnosis for island patients and Scotland's biggest telehealth system are among a raft of hi-tech projects to help more patients be treated quicker and closer to home.

EHealth investment totalling £1.6million - including funding from the NHS's major IT partner - has been announced today by Scottish Health Secretary Nicola Sturgeon.

Speaking at the first annual Scottish Telehealth and Telecare conference, Sturgeon unveiled details of projects extending the use of electronic technology in the NHS, including:

 

Touch screens in the homes of hundreds of patients with chronic conditions in Lothian, allowing them to be monitored from home;

 

 

Online scanning allowing patients in Orkney to be diagnosed remotely, avoiding lengthy trips to hospital;

 

 

New software in Glasgow transmitting patients' records directly to consulting rooms.

 

"Telehealthcare technologies and eHealth have huge potential to benefit patients, by harnessing all that technology can offer to make care quicker, safer and closer to home. It also allows more efficient working and better support for our health and care staff," Sturgeon said.

"In eHealth, our joint investment in 16 pilot projects will help patients in hospital and at home. At the West of Scotland Heart and Lung Centre, for example, they're replacing cardiac databases with the latest systems to improve patient safety.

"Together with NHS Lothian, we're also rolling out Scotland's biggest telehome monitoring system. Four hundred people living with conditions like heart failure or chronic lung disease will have touch screens to monitor their vital signs from home, helping them avoid repeated hospital visits."

The overall eHealth funding announcements made by the Cabinet Secretary totalled £1.6million - £564,000 of which comes from the Atos Origin Alliance, an innovation fund from the NHS's main IT partner.

The Atos Origin Alliance comprises Atos Origin, BT, IBM and Sopra Group.

The roll-out of the £700,000 telehealth project for long term-condition patients is funded equally between the Scottish Government and NHS Lothian.

Shocker: Doctors Work When They're Sick

iStockphoto.com

Take a sick day, doc.

How do doctors work around so many ill people without getting sick? Well, they don't.

Even if they scrub their hands like crazy, which certainly helps, they succumb to germs every once in a while, just like the rest of us. And also like lots of the rest of us, they'll go to work sick, a survey of medical residents finds.

A little more than half of the 150 residents surveyed at an Illinois medical meeting in 2010 said they'd worked while having flu-like symptoms in the previous year. And about one-quarter said they'd done so at least three times.

Why? They were just being responsible. More than half � 56 percent � said they felt a responsibility to take care of their patients. Fifty-seven percent said they didn't want to make their colleagues cover for them.

 

The results were published in the latest Archives of Internal Medicine. In a note about them, Dr. Deborah Grady wrote:

"Working while sick may demonstrate an admirable sense of responsibility to patients and colleagues, but clinicians also need to worry about the real danger of infecting vulnerable patients as well as colleagues and staff."

Now, don't you sometimes feel the same way when the cougher in the next cube won't take a sick day? We did our own survey in 2010 and found that almost three-quarters of people had gone to work sick in the past year.

The top reason, cited by 25 percent of people, was that they wouldn't get paid for the absence. That was followed by people saying they weren't sick enough to stay home and "work ethic" came in third at 19 percent.

Roundtable forecasts big changes for state HIEs

WASHINGTON – A new report from the HIMSS State Advisory Roundtable argues that state HIEs will need to adapt to changing approaches to reimbursement, evolving their mission and business models from "information exchange" to "coordination facilitation."
 
Convened about this time last year, the HIMSS State Advisory Roundtable comprises experts and advocates from state and federal governments, regional extension centers, health information exchanges and more. It seeks to target health IT issues that transcend state boundaries, helping enable different states advance their health IT programs.

Its inaugural report, titled "States Will Transform Healthcare through Health IT and HIE Organizations," was published at the HIMSS Government Health IT Conference and Exhibition in Washington, D.C., earlier this week.

Two of the roundtable's members are former Vermont Gov. Jim Douglas and former Wyoming Gov. Jim Geringer. In a blog post on the Government Health IT website, they wrote that, with many states still finding themselves "far behind where they were economically when the recession started 4.5 years ago," a key way "to address the economic challenges of many state budgets is to encourage our states to invest in health information technology."

But there's no shortage of challenges along that road, especially with regard to funding, infrastructure, sustainability, and, most notably, a healthcare industry that's in the throes of reinventing the very basis of its business model – steering away from fee-for-service and toward value-based care.

Other challenges faced by the states include a surge in Medicaid patients – with some states anticipating a more than 50 percent increase in enrollees – and pitfalls with regard to patient engagement. "Putting data in the hands of patients should be a major component in both enabling transparency and driving responsibility of the individual’s and family’s health," according to the report. "This is a challenge due to the complete lack of transparency between the caregiver, the payer and the patient today."

Health information exchanges are another area of concern – but also hold big potential, the report argues.

"Almost all states have large contracts in place for a more extensive build that is just getting underway now," it points out. "Stage 2 Meaningful Use will drive much more rapid development but that is no guarantee of success of state run HIEs. There has always been a concern about state run HIEs being able to compete with private options that are emerging as the market organizes.?

Indeed, there are big questions about many exchanges' sustainability.

"With few exceptions, such as Rhode Island and Vermont, the state-level HIE business model is almost completely void of private investment, leveraging mostly state and federal funds for development and implementation activities," according to the report. "Most models that have found success to date are based on driving efficiencies to providers in a fee-for-service model."

But as that outdated model fades in favor of value-based care, "the sustainability model for HIEs also must change," the report argues.

"This will likely come in the form of leveraging HIEs for care coordination, telehealth visits and quality and payment analytics. Therefore, the business of state HIEs will likely need to shift from 'facilitator of sharing' to 'data aggregator and analyzer' in order to build a sustainable business plan. The challenge will be to provide a basis for comparison across private providers."

[See also: States lead the way on healthcare IT.]

In their blog post, governors Douglas and Geringer offered other advice:

States should leverage their HIEs and other IT infrastructure in "new and innovative ways," such as closer partnerships between state governmental entities, regional extension centers, Beacon Communities and professional trade associations.Health IT "transcends political lines" and should be a top legislative priority, regardless of which part is in power, to maintain its forward momentum.States should "facilitate, engage and educate patients and consumers with the delivery of their healthcare services and promote overall increase in health literacy."Health IT should be foundational to healthcare reform.As that reform drives the shift from "fee-for-service to pay-for-quality models," state-level HIEs, to remain sustainable, will need to rethink their approach, from “health information exchange” to “healthcare coordination facilitation."Better coordination is needed between and among federal and state health agencies to make sure state-level HIEs are aligned with funding sources to ensure success.

Access the HIMSS State Adivsory Roundtable's report here.

 

U.S. ranks near last in value-based healthcare, report says

BOSTON – A report released Wednesday from Boston Consulting Group shows the United States trailing behind eight countries with regards to value-based care adoption, suggesting criticism of the U.S. healthcare system may be merited.

The Boston Consulting Group (BCG) study examined the progress of 12 industrialized countries in adopting value-based healthcare – an approach experts say would improve health outcomes while also reducing the industry’s expenditures. 

The report, title, "Progress Toward Value-Based Health Care: Lessons from 12 Countries," evaluates national health systems along two dimensions. 

The first is the degree to which key supports of value-based healthcare are in place at the national level – for example, common national standards and IT infrastructure, national legal and consent frameworks, the ability to link health outcomes with costs and high engagement on the part of clinicians and policymakers. 

The second is the quality of a country’s existing disease registries – institutions that track selected health outcomes in a population of patients with the same diagnosis or who have undergone the same medical procedure – both in terms of the richness of the data and the sophistication of the medical community’s use of the data.

“When it comes to implementing value-based healthcare, Sweden is the most advanced country of the 12 we studied, followed by Singapore, Canada and the U.K.,” said Neil Soderlund, a BCG partner and coauthor of the report. “By contrast, Germany and Hungary have the furthest to go.”

The U.S. health system, which has the highest per capita costs of the 12 nations studied and spends 17.6 percent of GDP on health care, is also one of the laggards in the group. 

Some experts say the fragmented nature of the U.S. healthcare system has limited the collection and use of national health-outcome data. “Reporting standards and clinical outcome metrics differ substantially across the system, even within the same specialty,” said Peter Lawyer, a BCG senior partner and coauthor of the report. “There currently exists no national mechanism for compelling providers to report outcomes to disease registries. Nor is there a unique patient identifier in place that would enable research to combine data across different disease states to examine the effect of complex comorbidities.” 

“We learned that a number of countries have begun to build the infrastructure and processes to support a value-based approach, but some are significantly farther along the learning curve than others,” said Stefan Larsson, MD, a BCG senior partner and coauthor of the report. 

The challenge for U.S. healthcare executives and regulators is how to close the gap with the rest of the world. “Notwithstanding the politics of health care reform, reimbursement is moving from a volume basis to outcomes,” noted Martin B. Silverstein, MD, a senior partner and former global leader of BCG’s Health Care practice.

For more widespread and systematic use of disease registries to take hold, key stakeholders will need to champion them, he added. “National medical societies, in particular, have a leadership role to play,” said Silverstein, “both in creating uniform standards for data collection and in securing broad support and participation of practicing clinicians.”

The federal government can also support registries, he said, “by creating a legislative and regulatory framework that facilitates their establishment and by providing seed funding to get them up and running.”

Military to employ IT to improve traumatic brain injury care

WASHINGTON – The Military Health System will spend $14.1 million to enhance the collection of traumatic brain injury and associated behavioral health information for military service members throughout the entire continuum of care.

The program is managed from MHS' Defense Health Information Management System program office in support of the Department of Defense and Department of Veterans Affairs overarching response to the President's Commission on Care for America's Returning Wounded Warriors.

The Military Health System tapped Vagent, Inc. to do the job. Vangent will develop a clinical information technology solution to improve the workflow of patients' behavioral health information and integrate with the military's electronic health record.

When deployed, the technology will make behavioral health patients' information more quickly available for diagnosis, treatment and ultimately positive clinical outcomes, officials said.

Vangent's subcontractors include Akimeka, LLC; Guident, Inc.; Enterprise Information Management, Inc.; Forgentum, Inc. and n-tieractive, Inc.

"The Traumatic Brain Injury and Behavioral Health Clinical Data Documentation solutions are imperative to providing clinicians a tool to improve the treatment of our Wounded Warriors," said Mac Curtis, president and CEO of Vangent, Inc. "With Vangent's broad experience in healthcare, we are leveraging our experience to rethink the technologies and solutions utilized by our front-line clinicians providing care to their patients."

The award represents a major win for Vangent, which has grown its portfolio of military health business to more than $140 million over the past year providing mission critical services and support for health initiatives within the Department of Defense.

Other major contracts include the common user database for the Force Health Protection & Readiness Program, e-commerce operational system support for the TRICARE Management Activity and executive information and decision support for the Military Health System.

More docs questioning benefits of ACA, EHRs

WATERTOWN, MA – Physicians remain concerned over the future of U.S. healthcare, a new survey reveals. Among the survey’s findings, most physicians think EHRs and the ACA will adversely affect the quality of patient care, and nearly two-thirds anticipate that quality of healthcare will worsen over the next five years. 

The Physician Sentiment Index (PSI), conducted by Watertown, Mass.-based athenahealth and Cambridge, Mass.-based Sermo, collected responses from 500 physicians who represented a diverse range of specialties and practices sizes. 

This year's PSI tells a story of over-burdened physicians who are deeply concerned about where the healthcare industry is headed. The data suggests the leading distractions affecting physicians' ability to provide the optimum care for patients center on government intervention, increased utilization of and frustration with EHRs and administrative burdens. All told, these distractions have diminished physicians' optimism around their ability to deliver quality care and remain viable, profitable practices. 

"There is a lot of ‘stuff’ going on in healthcare that is making the noble pursuit of the MD degree a lot less attractive," said Jonathan Bush, athenahealth CEO and chairman. "Government involvement, ill-designed EHRs and administrative complexities are encroaching on the sacred relationship between the physician and the patient and the ability for that doctor to be fully present at the point of care."

"U.S. healthcare is changing rapidly, but time and again policymakers aren't listening to the physician perspective," said Jon Michaeli, VP of membership for Sermo. "As a result physicians feel disempowered to influence change, and hence they are more disenchanted with their profession and less connected to patients than ever.”

More specifics of the survey’s findings are listed below: 

Doctors skeptical of regulation

Over half (in 2012 and 2011) say that government involvement in regulation will not yield lower costs and better outcomes, with slightly more pessimism on display this year.A growing number concerned about the ACA’s impact on the quality of care:  Nearly one-third (29 percent) say they still do not understand the details and implications, compared to 22 percent in 2011.16 percent said they'd like to see the ACA remain 'as is' (versus 11 percent in 2011).53 percent report the ACA will have a detrimental effect on their ability to provide high quality care, versus 50 percent in 2011 – 43 percent more believe the ACA will be very detrimental to the delivery of quality of care (from 14 percent in 2011 to 20 percent in 2012).26 percent want to see the entire ACA repealed (versus 21 percent in 2011).Three-quarters report that the meaningful use process is at least somewhat difficult and/or cumbersome.The ACO model draws concerns: More indicated ACOs as having a negative impact on quality of care (39 percent in 2012 versus 26 percent in 2011) and profitability (63 percent in 2012 versus 48 percent in 2011).

EHRs – more purchased, more in use, but what do docs think?

73 percent said EHRs are a distraction to doctor-patient interaction, up 12 percentage points from 2011.The number who purchased an EHR jumped 10 percentage points between 2011 and 2012 (from 70 percent to 80 percent). – Yet, very favorable opinions did not move in line –18 percent fewer voiced a very favorable opinion of EHRs (from 39 percent in 2011 to 32 percent in 2012).36 percent more say they believe EHRs somewhat or significantly worsen patient care (from 11 percent in 2011 to 15 percent in 2012). The majority (44 percent) says that the EHR was not designed with physicians in mind versus 32 percent in 2011.

Administration woes

89 percent said payers have become more intrusive on the patient-physician relationship versus 87 percent in 2011.74 percent said payers inhibit the care they would like to provide their patients (76 percent in 2011).59 percent more physicians see pay-for-performance as negatively impacting quality of care; 30 percent more believe it will negatively impact their bottom line.However, 42 percent are very/somewhat confident their transition to ICD-10 will be smooth.

[See also: Docs believe EHRs safer than paper, but patients still ambivalent.]

Independent physicians – fretting about the future of medicine, their viability

81 percent do not see the future of independent practice as viable, representing 19 percent more doctors in 2012 than 2011.This year, 50 percent more view the current healthcare climate as very detrimental to quality care delivery.Unchanged from 2011, about two-thirds anticipate that the quality of medicine in the U.S. will decline over the next five years.

 

Healthcare IT stimulus funding: Show me where to put the money

NASHVILLE – Now that the $787 billion American Recovery and Reinvestment Act has been signed into law, what does it mean for the healthcare industry, particularly for healthcare IT?

Providers and other healthcare IT stakeholders should focus on five areas that will likely be targeted by healthcare IT funding, said John Tempesco, vice president of Client Services and Marketing for Informatics Corp. of America, or ICA.

Ready-to-go healthcare IT projects that prevent medical mistakes, provide better patient care, promote preventative care, evaluate the most cost-effective healthcare treatments and drive cost-savings efficiencies will not only provide ROI but create jobs as well, he said.

Vendors should encourage their customers to expand healthcare IT projects and get them in place to be "shovel ready" for when the funding becomes available, he said.

"Because the focus is shifting away from automating the business of medicine to the clinical practice of medicine, the emphasis is now on informatics," Tempesco said.

Congress and demonstration projects by the Centers for Medicare and Medicaid Services, or CMS, have been focusing on clinical results and how physicians use information in healthcare IT platforms to reduce errors, make better-informed clinical decisions and deliver workflow efficiencies, he pointed out.

As a result, clinical informatics will be an area of job creation, he said. With increased physician involvement in the selection and deployment of solutions, hospitals should strengthen the relationship between their clinical and IT staffs. That will require clinical application specialists and medical technicians to help train staff.

What's missing in the healthcare industry is the actual teaching and translation of how providers use healthcare IT solutions in their daily workflow to make incremental changes in their businesses, he said. "There are not enough clinical application specialists in most hospitals," he said.

Tempesco expects stimulus funding to flow to community projects. ICA is already seeing a lot of Requests for Proposals from states, including Kentucky, Mississippi and Louisiana, for statewide health information exchanges, or HIEs. "Any time you talk about HIEs, it requires vendors producing data inputs and outputs, and hospital staff doing integration, implementation and training," he said.

Tempesco has a word of caution for those giddy with the forthcoming healthcare IT funding. "My biggest fear is that we dump money into projects that don't have sustainability plans," he said, referring to the community health information networks, or CHINs, that received government funding but failed in the 1990s.

If initiatives stick to the five key areas, Tempesco said, those projects would glean value.
 

First lady walks fine line on NYC drink proposal

WASHINGTON(AP)�First lady Michelle Obama says banning big servings of sugary drinks isn't anything she'd want to do at the federal level, but she offered some kind words Tuesday for New York Mayor Michael Bloomberg's effort to do just that. She later issued a statement backing away from taking a stand on New York's controversial proposed ban.

It was a telling example of the fine line the first lady walks as she tries to improve Americans' health and eating habits without provoking complaints that she's part of any "nanny state" telling people how to eat or raise their children.

Asked about Bloomberg's proposal during an interview with The Associated Press, Mrs. Obama said there's no "one-size-fits-all" solution for the country's health challenges. But she said, "We applaud anyone who's stepping up to think about what changes work in their communities. New York is one example."

And asked whether the nation's obesity epidemic warrants taking a more aggressive approach, such as Bloomberg's, she said: "There are people like Mayor Bloomberg who are, and that is perfectly fine."

Mrs. Obama later issued a statement saying that she hadn't intended to weigh in on the Bloomberg plan "one way or the other."

"I was trying to make the point that every community is different and every solution is different and that I applaud local leaders including mayors, business leaders, parents, etc., who are taking this issue seriously and working towards solving this problem."

"But this is not something the administration is pursuing at a federal level and not something I'm specifically endorsing or condemning."

In the interview, Mrs. Obama said she's "trying to create a big tent for people. Our motto is everyone has a role to play in this and I think it's up to communities and families to figure out what role they can play, what role they should play."

Last week, Bloomberg proposed limiting portion sizes of sugary drinks to 16 ounces at the city's restaurants, delis, food trucks, movie theaters and sporting arenas. Regular soda and sports drinks would be affected but not diet sodas.

The proposal is unpopular with most New Yorkers, according to a NY1-Marist poll conducted Sunday. A majority of New York City residents said the proposal was a bad idea and 53 percent said it was more government going too far than good health policy to fight the problem of obesity. The ban is expected to win the approval of the Bloomberg-appointed Board of Health and take effect as early as March.

Mrs. Obama spoke about the Bloomberg plan during an interview promoting her new book, "American Grown: The Story of the White House Kitchen Garden and Gardens Across America." The $30 book, which came out last week, traces the story of the garden on the South Lawn and of gardens around the country as the starting point for a national conversation "about the food we eat, the lives we lead, and how all of that affects our children," as Mrs. Obama puts it.

The first lady, wearing a print dress and periwinkle cardigan, enthused over green peppers coming into their own and a fig plant that's finally standing tall after a perilous infancy as she offered a walking tour of the garden. She ducked under some evergreens to point out a row of logs nailed to a post that will soon be sprouting shitake mushrooms.

Then, seated at a picnic table dressed up with a yellow checkered tablecloth, the first lady spoke of the progress that's been made in offering people healthier food choices and better nutrition information.

Mrs. Obama had just come from an appearance with Disney executives, where the company announced it would become the first major media company to ban junk food ads from its TV channels, radio stations and websites intended for children, starting in 2015.

Later in the day, she was scheduled to present a garden-related Top 10 list on CBS' "Late Show With David Letterman."

An example from her list, according to a CBS preview: "No. 7: In his lifetime, the average American will eat half a radish," she said, speaking from the White House Map Room.

And next Tuesday, she'll do a book signing at a Barnes & Noble in Washington � for a limited number of customers who buy a book this week and get a special wristband.

It's all part of the first lady's all-out effort to combat childhood obesity without provoking a backlash by pushing too hard. Mrs. Obama's high favorability ratings show she's largely been able to strike the right tone, a boon to her husband's re-election effort. But there is still sniping from some on the right who say they don't need a government lecture � or more intrusive steps � on what they eat or how they exercise.

Asked if she ever has to bite her tongue at Obama critics � legion in an election year � the first lady batted away the idea, saying she stays away from "all the chatter and the noise."

"It's not a difficult thing for me to do because we've got so much good stuff to talk about � like this book and the garden and getting our kids healthy and active," she said.

Mrs. Obama spoke of the enthusiastic response the garden has elicited from kids all over the country � but not so much from her own daughters.

"You know, they are not interested in gardening," she said. "I think it has a lot to do with the fact that I'm their mother and this is my interest, and they go in the opposite direction."

Learn all you can about health care alternatives

The following editorial is from www.Courier-Journal.com.

The challenge is for citizens to get involved. the public must do its part by educating itself about the various alternatives, and letting their representatives in Washington know what they conclude.

How broken is our current system?

Some 47 million Americans are uninsured; another 50 million are underinsured (not fully covered).

About 8.7 million children are uninsured.

Most bankruptcies have a health reason as a major cause, and 68 percent of those people who have gone belly up do have health insurance policies.

The World Health Organization ranks the level of U.S. health care at 37th in the world.

Private health insurance companies, which have doubled the premiums since 2000, have a bureaucratic overhead of 28-31 percent while Medicare operates at 3 percent efficiency. Therein lies a large part of the problem. These companies have an incentive to reduce benefits to patients.

The most persistent solution on the grassroots level is a single-payer system, the single payer being the federal government. This program involves a Medicare-type approach for everyone, but it would be expanded to include dental care, vision care and preventive programs. Overall, it would cost about the same — maybe a little more, maybe a little less — as the present 15 percent of the Gross National Product (GNP). All other industrialized nations with full coverage for all citizens average about half the costs in total medical care.

A single-payer system is best outlined in congressional bill HR676, which would set up the National Health Insurance (NHI) program. What it is not is “socialized medicine.” England and Spain have socialized medicine, wherein the doctors and hospitals are all employees of the federal government. Under HR676 the present system would stay; doctors would remain private vendors and would submit their bills to one payer, the U.S. government, not to the 1,500 private health insurance companies. Patients would still choose their doctors. (More about HR676 later)

Is a single-payer system just the blue-sky proposal of some Washington, D.C., think tank? Not by a long shot. It is the work product of Rep. John Conyers and has 90 other congressmen as co-sponsors. This is about one in five House members. Also endorsing HR676 are the U.S. Conference of Mayors (a nonpartisan group of 1,100 members), Physicians for National Health Care Program (more than 10,000 doctors), League of Independent Voters, the United Church of Christ and the United Methodist Board of Church and Society, 32 city councils (including Louisville, Indianapolis, Baltimore, Detroit and Boston), 14 national and international labor organizations, the American Medical Students’ Association, the National Family Farm Coalition and more.

There was a time when the doctors would (and did) kill any national health care plan in the womb. Today a solid 59 percent of U.S. physicians now support national health insurance. Particularly strong on the issue are psychiatrists (83 percent), pediatric sub-specialists (71 percent), emergency medicine physicians (69 percent), general internists (64 percent) and family physicians (60 percent). Doctors and hospitals have to employ huge staffs just to process insurance claims from a multiplicity of insurance firms. About 20 percent of private doctors’ income goes to pay for this staff.

Businesses are now leaning toward a national program. The Business Coalition for Single Payer Healthcare in New York (www.BusinessCoalition.net) poses this scenario: “If you own a small business with a $100,000-per-month payroll, your health care costs can be reduced from typically $15,000 per month to just $3,300 — from 15 percent to 3.3 percent of wages, a savings of $140,400 per year.”

General Motors, which says health care adds at least $1,500 to each car, is paying people to leave their jobs so they can hire replacements at 50 cents on the dollar with reduced health benefits. This may help the bottom line and the company can compete better, but it is a sad commentary on the state of American health care, especially for the newest of workers.

Neither of the two major presidential candidates favored a single-payer program. Democrat Barack Obama comes up with a halfway reform that includes the insurance companies in the mix. His plan would offer help to nearly half of the uninsured people and would cover all children. Republican John McCain’s plan was only a small reform that features a tax credit plan of $5,000 for a family. This wouldn’t come close to paying a normal $12,000 premium for family health care. And the McCain plan, from some analysts’ viewpoint, would offer help to only about 4 to 5 million uninsured people.

Neither Republican nor Democrat solutions take advantage of the tremendous savings realized from eliminating the waste in the private health insurance industry. This waste alone, by the estimates of several studies, would pay for health coverage for all of the uninsured. More than several states have tried systems of mandating and subsidizing policies from insurance companies. Minnesota, Tennessee, Vermont, Washington and Massachusetts have learned the hard way in failing to fix the system by including the health insurance industry.

Where else would the money come from to support a national program? HR676 calls for a modest payroll tax on all employers and employees of 3.3 percent each, in addition to a 1.45 percent tax that they are already paying for a total of 4.75 percent each. Also there would be a 5 percent health tax on the top 5 percent of income earners and a 10 percent tax on the richest 1 percent . A small tax on stock and bond transfers is also envisioned along with the closing of corporate tax loopholes and repealing the Bush tax cut for the highest 1 percent of income earners.

When you subtract the cost of insurance premiums, the deductibles and the co-pays, most businesses and most people would pay less for national health care than they do today. Even if the cost did go up some, the coverage would be much broader and medical needs would be met much more easily.

What we are learning is that the United States is all alone among its peers in the whole world. This is the only country that treats health care as a commodity distributed according to ability to pay, rather than as a social service distributed according to medical need.

The challenge is to get fully informed citizens involved in changing things for the better.

DAVID ROSS STEVENS
Borden, Ind.

Mr. Stevens is a member of the Southern Indiana branch of Hoosiers for a Commonsense Health Plan (whose Kentucky counterpart can be reached at www.kyhealthcare.org).

What Obama’s Next Steps Should Be on Health Care

The following article is from AlterNet. AlterNet asked dozens of writers, experts and activists on key issues to write about where the country needs to go, and the priorities for Barack Obama’s early days in office.

By Sara Robinson, fellow, Campaign for America’s Future

The most important thing for incoming Obama policy makers to remember right now is that, while Obamacare is a fine step in the right direction, they shouldn’t be shy about using the words “single payer.” (Or, put it another way: Medicare for all.) The K Street lobbyists for the insurance and pharmaceutical companies may scream bloody murder whenever the idea is floated, but the polls over the past several years have shown irrefutably that the American public — including a majority of Republicans — is behind this idea at least 2 to 1. That’s a lot of political cover, and they should take full advantage of it to do the right thing.

It’s also an absolutely necessary thing. American workers are competing with European and Canadian workers who have the choice to go back to school, start a small business, take time off and travel, stay home with their kids for a few years, fully recuperate from a disabling condition, or tell their boss where they can stick it without the threat of losing their insurance. Having guaranteed health care not only makes these workers physically healthier and extends their productive years; it also increases these countries’ social and economic capital by enabling them to become better skilled, better traveled, more entrepreneurial and more personally fulfilled. American workers simply can’t compete on an equal footing in a tight global labor market until they have equal access to care.

It’s also the right thing to do economically. A new Harvard Law School study found that more than half of the mortgage defaults underlying the subprime meltdown were triggered by overwhelming medical bills or job loss due to disability. It’s probably not an overstatement to say that much of America’s current financial distress is the direct product of our health care crisis. (It’s ironic that the same financial wizards who so boldly proclaimed that we were all on our own — or should be — are now losing everything because they simply didn’t notice how interconnected these issues are. If they’d shared just enough of their loot to ensure that Americans had decent health care, they’d still be Masters of the Universe. They didn’t. So we don’t. So they aren’t. Who says there’s no such thing as karma?)

Most importantly: It’s the best thing an incoming Obama administration can do to usher in a new and enduring progressive era. Giving every American access to health care will do more to undercut the entire conservative worldview and replace it with a new progressive political philosophy than anything else you can name. Once people realize that government can do this much good for this many people, it will restore our faith in the power of democracy — and when that happens, all manner of now-impossible things will suddenly become possible.

Report: N.Y. school with sick teens not toxic

ROCHESTER, N.Y.�Additional environmental testing at a Le Roy, N.Y., high school where a cluster of students had unusual neurological symptoms earlier this year has found no evidence of contaminants that could be linked to the facial tics and verbal outbursts.

In a community letter released Wednesday afternoon, Le Roy Central Schools Superintendent Kim Cox said, "I have excellent news. There are no adverse health impacts from contaminants in the air, soil or water in or around our high school campus."

The additional tests were done after an outcry over the appearance of unusual neurological symptoms among as many as 18 students in the Genesee County, N.Y., district's junior and senior high schools, which share a building.

A number of medical experts eventually said the most likely explanation for the cluster was conversion disorder, a stress-related, possibly neurological condition in which patients display symptoms of psychological origin. The condition often eases over time; as of a few months ago, some students were said to be showing improvement.

On that point, Cox's letter said only "the best news of all is that our students are doing well."

Concern about the cause of the health problems prompted one round of tests last fall that found no contaminants in the structure.

But when the cluster of illnesses drew national attention in January and the furor mounted in Le Roy, Cox said more comprehensive testing would be done to allay parents' and students' fears that an environmental contaminant might have triggered the symptoms.

The resulting study by Leader Professional Services of Perinton, N.Y., made public Wednesday, said nothing unexpected was found and nothing was present at levels that could cause harm.

There was no detection of the industrial solvent trichloroethylene, or TCE, which some -- including environmental activist Erin Brockovich -- had worried might have migrated from a 1970 spill site three miles away. There also was no evidence of other contaminants such as mercury or formaldehyde and no unusual level of fungi in the schools' air.

Carbon monoxide levels were acceptable, although elevated carbon dioxide was noted. The latter is not a health concern, the report said.

Arsenic was found in soil near a school-owned natural gas well in a concentration slightly above New York state cleanup guidelines. The gas well, which is behind a chain-link fence, is one where a tank that holds brine from the well had previously overflowed. The study suggested the arsenic was naturally occurring.

Finally, A Map Of All The Microbes On Your Body

Enlarge Ayodhya Ouditt/NPR

Ayodhya Ouditt/NPR

Scientists Wednesday unveiled the first catalog of the bacteria, viruses and other microorganisms that populate every nook and cranny of the human body.

Researchers hope the advance marks an important step towards understanding how microbes help make humans human.

The human body contains about 100 trillion cells, but only maybe one in 10 of those cells is actually � human. The rest are from bacteria, viruses and other microorganisms.

"The human we see in the mirror is made up of more microbes than human," said Lita Proctor of the National Institutes of Health, who's leading the Human Microbiome Project.

 

"The definition of a human microbiome is all the microbial microbes that live in and on our bodies but also all the genes � all the metabolic capabilities they bring to supporting human health," she said.

These microbes aren't just along for the ride. They're there for a reason. We have a symbiotic relationship with them � we give them a place to live, and they help keep us alive.

"They belong in and on our bodies; they help support our health; they help digest our food and provide many kinds of protective mechanisms for human health," Protor said.

Microbes extract vitamins and other nutrients we need to survive, teach our immune systems how to recognize dangerous invaders and even produce helpful anti-inflammatory compounds and chemicals that fight off other bugs that could make us sick.

"These microbes are part of our evolution. As far as we can tell, they are very important in human health and probably very important in human disease as well," said Martin Blaser of New York University.

These bugs generally don't make us sick. But when we disrupt the delicate ecosystems they carefully construct in different parts of our bodies, scientists think that can make us sick.

"There can be a disturbance in the immune system. There can become some kind of imbalance. And then you can get a microorganism which, under normal circumstances, lives in a benign way and can become a disease-bearing organism," Proctor said.

Taking too many antibiotics, our obsession with cleanliness and even maybe the increase in babies being delivered by Caesarean section may disrupt the normal microbiome, she said.

So the idea behind the micobiome project was to get the first map of what a normal, healthy microbiome looks like.

More than 200 scientists spent five years analyzing samples from more than 200 healthy adults. The samples came from 18 different places on their bodies, including their mouths, noses, guts, behind each ear and inside each elbow.

"This is the only study to date anywhere in the world where peoples' microbiomes across a human body were sampled and analyzed. Here was an effort to really investigate the full landscape, if you will, of the human microbiome across the body," Proctor said.

Scientists identified some 10,000 species of microbes, including many never seen before, according to the first wave of results, which are being published in 16 papers in the journals Nature and PLoS.

"This is like going into uncharted territory � going into a forest and finding a new species of butterfly or new type of mammal or something like that � a new kind of bird," said George Weinstock of Washington University in St. Louis.

Those 10,000 or so species have more than 8 million genes, which is more than 300 times the number of human genes.

And scientists found some very interesting things when comparing microbiomes.

"People were very different from each other, but skin was more like skin and gut was more like gut. So the composition of microbes and the kinds of genes that they have are very much habitat-specific," Proctor said.

Now that scientists have an idea of what a healthy microbiome looks like, they can start to explore this super-organism � this complex mishmash of human and microbial cells.

"How do they talk to our human cells? And how do human cells talk back to them? Because it's really a concert that they're playing together, and that's what makes us who we are," Weinstock said.

Scientists have already discovered some intriguing clues. For example, the microbes in a pregnant woman's birth canal start to change just before she gives birth. Scientists think that's so their babies are born with just the right microbiome they'll need to live long, healthy lives.

Health Care’s New Trend: Spending Dollars More Wisely

Today, a new report from the Centers for Medicare & Medicaid Services included good news for consumers and our health care system. This report provides more evidence that the health care law will help control costs and save money for families while extending coverage to millions of Americans. According to the new report:

Health care costs stay steady. Contrary to claims made by opponents of the health care law, today�s report found that the Affordable Care Act did not result in increased health care costs. In fact, the report showed a slight decrease in costs in 2011.Consumers will save money. Out-of-pocket spending will decrease by 1.5% as provisions of the Affordable Care Act � the health care law � kick in. In the short run, consumers won�t see the kind of price hikes on prescription drugs they have become accustomed to in recent years. The report finds that growth in prescription drug spending will decline from 3.9% in 2011 to 2.9% in 2012 and to 2.4% in 2013. That�s real money back in the pockets of millions of Americans.No increase in national health spending as a percent of GDP for five years. From 2009 through 2013, national health spending will not increase as a percent of the economy.Slower growth in health care spending once changes are implemented. The Affordable Care Act is projected to insure over 30 million additional Americans, resulting in improved access and thus health spending as they gain coverage.� Once implemented, the report shows that national health spending growth is projected to be lower than it would have been without the health care law from 2017 through 2019.

This report is consistent with other recent reports, one of which stated: �Four years of historically low growth is noteworthy and we may be at the start of a new normal.���

The health care law has contributed to these results and will continue to help move us forward.� We�re rooting out fraud and abuse, and have stopped people across the country who are scamming the Medicare system.� Medicare is making cutting-edge payment reforms, such as demonstrations launched by the CMS Innovation Center that will test models that save money and improve care, and help ensure that these models are replicated across the country.� We have implemented policies to hold insurance companies accountable.� And, we�re investing in primary care and prevention that will help keep small health problems from turning into big ones.

Thanks to reforms like these, the Affordable Care Act is helping control health costs and expand coverage, and ensure better health and better health care, for all Americans in the next decade and well beyond.

Big 3, UAW Ask for Health Trust Help

The following article is from DetNews.com.

Cash-crunched automakers state need for payment help in their bid for federal financing.

By David Shepardson / Detroit News Washington Bureau

WASHINGTON — Detroit’s Big Three and the United Auto Workers are pressing the case for low-cost government loans to help automakers make required payments to trust funds to oversee hourly retiree health care starting in 2010.

The need for congressional support for the health care funding isn’t their most immediate concern, but it’s looming. The automakers are asking Congress for as much as $25 billion in “bridge financing” to help with their liquidity crisis, but that money also could be used for funding the health care trust.

Congress could consider that request, which is separate from the $25 billion already approved for low-cost loans for retooling plants to build more fuel-efficient cars, when it returns to work this month.

The topic of the health-care payments was addressed during an hour-long meeting of House Democrats convened by House Speaker Nancy Pelosi on Monday.

In total, Detroit’s Big Three automakers will make nearly $60 billion in payments to bankroll three trust funds to pay for hourly retiree health care.

In July, General Motors Corp. announced it had won permission from the UAW to push back $1.7 billion in payments owed in 2008 and 2009 to its Voluntary Employee Beneficiary Association fund that will cover health care for UAW retirees. GM will make the payments in 2010, when the UAW assumes responsibility for the fund.

That means GM will pay the $1.7 billion, plus accrued interest of 9 percent adding to the $5.3 billion already scheduled for 2010. They will be the first payments as part of a deal to give the UAW about $34 billion in cash and stock to assume $51 billion in GM’s retiree health care liabilities.

The shift to a VEBA to pay for retiree health care is the largest part of the 2007 labor contract that will reduce GM’s annual costs by $3 billion starting in 2010.

But GM faces a liquidity crisis now that analysts say may require outside help for it to survive beyond 2009, or to be able to make the payments to the trust fund.

Chrysler is to make payments totaling $9.8 billion into the fund, including $6.6 billion in 2010. A merged GM-Chrysler could face a staggering bill. Chrysler will also issue a note to the UAW worth $1.2 billion that’s due in 2016.

Ford is to pay between $13.2 billion to $15 billion into its retiree health care trust, based on the company’s future stock value. Ford took a $4.5 billion cash charge toward its retiree health care funding requirements this year, according to its second quarter filing.

UAW legislative director Alan Reuther said the financial ability of automakers to make the payments into the trust fund in 2010 is a concern, and one of the issues that should be addressed by Congress.

“If the federal government does not provide assistance to the Detroit-based auto companies to enable them to survive the economic downturn, hundreds of thousands of jobs at the auto companies and suppliers will be threatened,” UAW President Ron Gettelfinger wrote in an Oct. 27 letter to lawmakers. “The health care and pension benefits for the retirees and their families will be placed in jeopardy.” He noted that the government could be forced to assume a large increase in health care and retiree costs if the Big Three collapsed.

Detroit’s Big Three automakers spent $8.9 billion on health care in 2007, compared with a record $11 billion in 2005.

Automakers have said they think Congress should consider all available options to assist automakers.

About 1 million retirees and spouses receive health care and pensions from Detroit’s Big Three automakers, typically getting less than $20,000 per year.

Harley Shaiken, a professor specializing in labor studies at the University of California-Berkeley, said automakers need help with the impending costs.

“Without assistance, this is going to be a serious problem for automakers,” Shaiken said.

Top CEOs offer checklist for better healthcare

WASHINGTON – Some of the nation's top healthcare CEOs have issued a 10-item checklist for spurring high-value healthcare that includes health IT best practices.

The checklist is part of a discussion paper the CEOs authored that bears the emblem of the Institutes of Medicine. However, it also carries a disclaimer that the views expressed in the discussion paper are not necessarily those of the authors’ organizations nor of the IOM.

[See also: IOM to release new report on health IT and patient safety]

"The Checklist’s 10 items reflect the strategies that, in our experiences and those of others, have proven effective and essential to improving quality and reducing costs," the authors write.

On the topic of IT, they state: “Reliable information systems are critical not just to ensure care quality, but also to improve efficiency in administrative and other process measures.”

In keeping with their precept of “continuous improvement,” the CEOs ask themselves and their senior leaders these questions about IT:How well is our IT system used to help providers streamline administrative tasks and improve the care experience and patient outcomes?How well is our EHR aligned with meaningful use requirements?

[See also: IOM finds healthcare data for children lacking]

They also present examples of how IT best practices resulted in better care and millions in savings at their organizations.

At Geisinger Health System, for example, IT helped lower costs over the past five years, saving $1.7 million from reduced chart pulls; more than $600,000 from reduced printing and faxing; more than $500,000 per year from reduced nursing staff time through ePrescribing; and more than $1 million from reduced transcription.

The checklist and a list of the authors and their affiliations are on the next page.

Stimulus package a vote away from becoming a law

WASHINGTON – The House voted Friday afternoon to approve the final version of the $787 billion economic stimulus bill by a 246-183 vote, according to CNN reports.

A final Senate vote was expected by Friday evening, leaving the bill awaiting only President Barack Obama's signature to become law. Obama has said he would like to sign the law in a televised ceremony on Monday.

According to CNN, no House Republicans voted in favor of the bill, and seven Democrats voted against it.

The bill will need three Republican votes to pass in the Senate. Maine Sens. Olympia Snowe and Susan Collins and Sen. Arlen Specter from Pennsylvania are expected to support the bill.

The bill is loaded with money for healthcare reform and the advancement of healthcare IT. It includes $19 billion for healthcare IT and more than $100 billion for healthcare measures including funding to help beef up state Medicaid coffers and subsidies to help unemployed workers afford healthcare coverage through COBRA.

"The economic stimulus package represents a significant step forward for the advancement of healthcare in the United States," said Harry Greenspun, chief medical officer for Perot Systems. "These funds should significantly advance patient safety and care while creating good paying jobs in the health IT sector, especially if we can achieve the goal of developing an electronic health record of every American."

Everyone Wants Healthcare Reform

Written by Timothy Fisher

I spent much of Election Day at the polls helping collect signatures to support a single-payer health care initiative. Given the great turnout for this year�s election, this was an excellent way to get a sense of who really lives in one�s town. In this increasingly polarized world, it�s probably the one event where almost everybody shows up. Left and right, young and old, working, retired, students and families all in one place and all strolling by my little table. Many did that exactly, strolling right on by without any interest in signing anything for anybody. But of those who chose to stop, the interest in this issue was profound.

We all know that the skyrocketing cost of health care is a problem all over the country. But until you spend a day talking with folks from all walks of life about their own experiences, it�s hard for it to really sink in. It truly seemed that everybody is fed up with the health care system we have now. Of course there were those who believe that easy access to health care ought to be the right of every American, rather than the privilege it is increasingly becoming today. They all signed this petition. But they were hardly alone. There were people who were just plain sick of paying gobs of money for a high-deductible plan and then still paying all of their medical bills anyway. There were people paying more for these �catastrophic coverage� plans than the mortgage on their home. Many signed who were only holding onto a job for fear of losing the insurance. This was especially scary for one woman who wished to retire but needed her company�s plan to support her husband�s medical needs. There was an Iraq war veteran who felt well cared for by the military, but was frustrated to watch his young adult daughter unable to afford her own coverage.

More than a few signed who didn�t like the idea of tax-supported health care, but thought that �we just have to do something!� Everybody sees the need for change. And everyone has some horror story about their own family or friends who battled the insurance company to fulfill their promises or ER visits that break their budgets or having to choose between food, fuel or medicine. People are so desperate for help.

Pretty much everyone under age 50 signed my paper, as did anyone with a kid attached to their leg. Maine is a place where many people work for themselves and they especially are being left behind by today�s system. Carpenters, plumbers, artists, store owners, farmers and pretty much every fisherman signed this paper. None of these people wants more taxes, but more importantly, I think all these people want to feel they�re getting something back from paying those taxes. In the last few years we�ve watched in dismay as our leaders dish out billions upon billions to fund a war far away from home, and then to bail out the rich on Wall Street. Now there�s talk of bailing out the auto industry because they had a serious lack of foresight. It�s not too big a stretch to imagine us soon bailing out the health insurance companies. As premium costs rise, more people and businesses will drop their plans, thereby making the costs rise yet again. The whole industry is on a path to failure. We need to change it now before that happens. We need to change it in a way that supports the people rather than the corporate world. As our new president, Barack Obama will have many of the pieces in place to make real change in our health care system and he appears to have the desire to do so. But his current ideas are marginal at best. He needs to be pressed right now on what the people want this system to be. If it�s not working out for you, write or call your representatives and tell them what you want the American health care system to be.

Anyone interested in more information can check out: www.midcoasthealthcarereform.org.

Thank you to those who helped collect signatures last week, and also to everyone who signed this petition and even to those who did not sign but took the time to stop and discuss this crisis.

Timothy Fisher is a resident of Prospect Harbor.

Leapfrog grades hospitals A to F on patient safety

WASHINGTON – A new report card from healthcare watchdog The Leapfrog Group ranks hospitals for patient safety – A through F. Infections, medication and medical error and injuries are still rampant, according to Leapfrog's survey. Massachusetts hospitals ranked high. Those in the nation's capitol had the lowest average scores.

Approximately 400 people die every day because of hospital errors – the equivalent of a jet crashing every day and killing all aboard, Leapfrog notes. In response to this silent epidemic, more than 2,600 U.S. hospitals will now receive an A, B, C, D or F Hospital Safety Score based on patient safety via a first-of-its-kind initiative.

[See also: Leapfrog Group names top hospitals for 2011]

A blue ribbon panel of the nation’s top patient safety experts provided guidance to the Leapfrog Group, an independent national nonprofit run by employers and other large purchasers of health benefits, to develop the Hospital Safety Score. The Hospital Safety Score is calculated using publicly available data on patient injuries, medical and medication errors, and infections.

Not all hospitals earned an A, and there are some surprises, including hospitals with outstanding reputations for quality appearing with Hospital Safety Scores of B, C or below.

"The Hospital Safety Score exclusively measures safety – meaning errors, accidents, and infections," said Ashish Jha, MD, of Harvard, a member of the blue ribbon expert panel. "Even hospitals with excellent programs for surgical and medical care, state-of-the-art diagnostic equipment, and dedicated physicians may still need this score as a reminder that patient safety should be a top priority."

[See also: Most hospitals fall short on safety measures, Leapfrog survey shows]

"The Leapfrog Group’s goal is to give patients the vital information they need and deserve before even entering a hospital," said Leah Binder, president and CEO of the Leapfrog Group. "We hope people will use this score to talk with their doctor, make informed decisions about where to seek care, and take the right precautions during a hospital stay."

For the first time, the Hospital Safety Score will highlight the country’s best hospitals and warn against the worst to save lives and bring attention to the nation’s silent safety epidemic. According to recent studies, one in four Medicare patients will leave a hospital with a potentially fatal issue they didn’t have prior to hospitalization. On average, one medication error per day occurs for each hospitalized patient, and more than 180,000 Americans die every year from hospital accidents, errors, and infections.

The Hospital Safety Score website allows visitors to search hospital scores for free, and also provides information on how the public can protect themselves and loved ones during a hospital stay.

"The Leapfrog Group board has been frustrated with the lack of progress in improving patient safety, despite significant industry efforts over the past decade," said David Knowlton, immediate past chair of the Leapfrog Group Board of Directors and chair of the Leapfrog Group’s Patient Safety Committee. "It is time for a game changer. It’s time to give American families the heads-up they need to protect themselves if they face the need for a hospital stay."

The Leapfrog Group’s membership of employers and other purchasers of health benefits, and business coalitions on health across the country, will be working to engage communities, employers, health plans, and hospitals in using the Hospital Safety Score to improve safety, Leapfrog executives said. The Hospital Safety Score will be reissued using updated data in November 2012, with an annual Hospital Safety Score to follow in 2013 and beyond.

Key findings:Of the 2,652 general hospitals issued a Hospital Safety Score, 729 earned an A, 679 earned a B, and 1243 earned a C or below.A wide range of hospitals earned A's with no one class of hospitals dominating among those showing the highest safety scores.Hospitals earning an A include academic medical centers Massachusetts General, NYU Langone Medical Center, and University of California San Francisco. Many rural hospitals earned an A, including Grinnell Regional Medical Center in Iowa and Baptist Health South Florida Homestead Hospital in Florida.Hospitals with myriad national accolades, such as Mayo Clinic, Virginia Mason Medical Center, and University of Michigan Medical Center, each earned an A.

Less predictable were the A scores earned by hospitals serving highly vulnerable, impoverished, and/or health-challenged populations, such as Bellevue Hospital, Montefiore Hospital, and Detroit Receiving Hospital.

"A" scores were awarded to for-profit hospitals including many in the HCA systems, as well as hundreds of not-for-profit and public hospitals.

Community hospitals showed excellence as well, such as OSF St. Joseph Medical Center in Illinois.

More on methodology and panel experts on next page.

Value-based purchasing elicits favor, concern among healthcare execs

NEW YORK – Paradigm shifts in the healthcare industry are more and more common nowadays – their prevalence being powered in large part by an explosion in information technology. It’s perhaps no surprise, then, that a Forbes Insights study released Tuesday showed that, among healthcare executives, value-based purchasing (VBP) continues to gain favor over traditional fee-for-service reimbursement. 

The Allscripts-sponsored report, which surveyed more than 200 hospital and health system executives, reflects the balancing act that’s necessary to get their organizations from so-called "way things have always been" to the "way things will be" – without tumbling into a financial chasm because of the "way things are now."

Seventy-three percent of the executives surveyed agreed or somewhat agreed that healthcare providers must now begin the transition towards VBP, which emphasizes paying for value rather than volume. 

This type of payment system – soon-to-be ubiquitous among healthcare facilities – will only precipitate greater quality of care, said Michael L. Millenson, president of Health Quality Advisors, and the author of the report. “What’s most impressive about [VBD] is the way hospital executives are preparing for the future in a very determined way.”

He added that "no one is rushing into anything, and at the same time, no one is pretending it’s not going to happen.” Instead, it's simply necessary to prepare for things that are going to happen three to five years down the road. 

VPB also brings with it myriad benefits for both the patient and the healthcare provider said Millenson. First, it encourages physicians to improve their practices, as the system measures and manages value on many different metrics. It gives quantifiable evidence, he continued, and it’s “not just medical evidence, it’s evidence as in report cards and data transparency.” 

Experts say VBP will also lead to greater transparency. No longer will hospitals and healthcare providers be able to take refuge behind an institution’s prestigious name. As, with increasing data transparency, the most renowned names in hospitals could, in reality, yield disappointing outcomes in patient care.

“Some of the biggest names in healthcare may or may not have the best care,” Millenson said, and “that’s good for the patient to know, and that’s good for the provider to know.” If weaknesses aren’t acknowledged, there can be no improvement. 

He cited Cadillac as an example. In the beginning, the car marque essentially enjoyed a monopoly in the luxury car market, establishing a name for itself. However, competitors emerged, and customers realized the brand name wasn’t always indicative of a quality product; thus fewer people were purchasing the cars. Cadillac, since then, has reformed itself, but it serves as an insightful example that can be extended to VBP. If a physician is compensated for the quality of administered care, and patients are more aware of the comparative landscape, the physician, proponents say, will have more incentive to improve if value is lacking.

[See also: Pay-for-performance plan gets mixed reaction at congressional hearing.]

Bottom line, Millenson said, is that VBP rewards people who deliver high-quality care, which is incentive for people to aim higher and to provide better overall care. With this system, he said, “We can now expect a certain amount of positive outcomes.”

Key findings of the study, titled “Getting From Volume to Value in Health Care: Balance Challenges & Opportunities,” included:

Disruptive potential of value-based purchasing. Nearly four in 10 respondents (38 percent) completely or somewhat agreed that VBP is likely to become a truly disruptive innovation.Crucial to win hearts and minds. Fully engaging their doctors was seen by surveyed C-suite executives as the top barrier to VBP participation, selected by half of respondents.A warning on consumer-driven health plans. About two-thirds of surveyed executives believed that consumer financial incentives are key to making VBP successful (64 percent). However, about the same percentage (67 percent) also thought that consumers won’t know when that success arrives, since they can’t judge the value of medical care accurately. That’s a warning sign for those who believe that the high-deductible health insurance arrangements known as consumer-driven health plans will automatically drive value-based purchasing on the part of the patient.VBP will require seamless communications. Nearly half of respondents chose system integration across all applications (49 percent) and health information exchange (47 percent) among their top IT spending priorities for VBP over the next three years.

Despite the challenges brought up, executives interviewed in greater depth shared a common optimism.

As Robert Margolis, MD, CEO and managing partner of Torrance, Calif.-based HealthCare Partners, put it: “You manage by having a strong vision people believe in, mission and values and lots of communication.”

Protests at White House healthcare hearing in Iowa

By Kay Henderson for Reuters–

DES MOINES, Iowa (Reuters) – The latest White House regional forum on healthcare drew protests and complaints on Monday along with a promise that government-run insurance was at least on the table for discussion.

“Why are we having this shameful event?” said Mona Shaw, a political activist, at the start of the session. “People are dying,” she said, because of what she termed a callous insurance industry.

Iowa Governor Chet Culver who chaired the event cued up a video message from President Barack Obama as security personnel escorted Shaw from the room.

It was the third of five regional meetings which Obama hopes would help Congress figure out how to overhaul the U.S. healthcare system, which is the most expensive in the world even though some 46 million Americans have no health insurance.

Obama plans to make sweeping changes to the system this year to try to cut the number of uninsured while improving the quality of care and controlling costs that are forecast to reach $2.5 trillion dollars this year.

About 20 protesters at the meeting waved signs and chanted “Everybody in, nobody out” — a demand for universal coverage.

Dr. Jess Fiedorowicz, a psychiatrist at the University of Iowa Hospitals who was with the protest group, told the meeting a majority of Americans support a “single payer” or government-run national health insurance program.

“Can we put it on the table for discussion?” Fiedorowicz asked Nancy-Ann De Parle, director of the White House Office on Health Reform.

“Can we study costing? Can we study feasibility of this truly universal, socially just and fiscally responsible alternate to our currently unjust and woefully inefficient system?” Fiedorowicz asked. Many in the crowd applauded.

Vashti Winterburg, 61, co-chair of Kansas Health Care for All, said she opposes any plan that keeps health insurance companies in business.

She said the Kansas nonprofit board she serves on is finding it more and more difficult to pay the premiums of workers who provide in-home care to the elderly.

Chris Peterson, 53, who farms near Clear Lake, Iowa, said he cannot buy private health insurance for his wife or himself two years after his insurance carrier dropped them. They now have $14,000 in medical debt.

From Reuters.com.