Computers, Health and Boston

A couple of items of note on health information technology:

Heathcare IT News reports that, Vish Sankaran, speaking in Boston for the federal HIT effort, said: “We don’t want the federal government to be in this business forever.” The aim, he said, is for government to “raise the bar, tip the market,” and then engage with the private sector…

Mass Device has a long Q & A with one of the local industry players: … PatientKeeper Inc. president and CEO Paul Brient on why healthcare IT won’t save the healthcare system, why it’s still crucial to healthcare reform and how it could revolutionize the practice of medicine.

A bit of background.  The idea that computers can cut health care costs seems pretty abstract. But, with all the money wasted on claims processing, prescribing errors and questionable care, it makes sense. Computers could get at the cost of administration, medical errors and unnecessary testing and treatment. So, the Feds are investing $2 billion into the push for electronic medical records, computerized prescribing and patient portals.  BHN and the Globe have reported that docs and policy makers from Massachusetts – in many cases on loan from Partners – are deep into the government planning. A huge industry is growing up around it, much of it here.

To see some of how this will work, see  a post from Dr. John Halamka on connecting BIDMC with a network of area doctors.  Dr. Halamka is the CIO of Beth Israel Deaconess Medical Center.

Nationally, the effort has hit some rough patches, he notes. In a recent blog post, the self-described geek doctor tries to put the setbacks into perspective.

It’s 2010 and everyone in healthcare IT is complaining. Meaningful Use is too hard. Too many grants have simultaneous deadlines. There are more policy and technology changes than ever before in history.

 

In another post, he and his class came up with a list of potential barriers to getting medical record into computers.

 The creation of a digital health will be complex and problematic. For a less wonkish, more local  perspective on all this, BHN senior writer Tinker Ready spent some time in Newburyport this fall reporting on the effort to wire that town for healthcare. Her radio report ran on WBUR radio’s “World of Ideas” on  Dec. 27.  Click here to listen to the Newburyport story alone or here to listen to the entire show.

Harvard Pilgrim for Governor

     It does have the magic “H” word in its name. (Not the be confused with   Harvard Vanguard, a group of now unrelated clinics and health centers.) From today’s Globe:

A Boston Globe analysis of contributor reports shows that in seven months (Republican Charlie) Baker’s campaign raised more than $122,000 in contributions tied directly to Harvard Pilgrim (health insurer.) This includes not only $43,000 in contributions from Harvard Pilgrim’s employees, directors, and affiliated companies, but also a broad array of vendors: its accountants, auditing firm, advertising agency, information technology providers, and consultants.

In backlash news, see the item in the NY Times Prescriptions blog/column on how no one loves the Mass plan anymore.  

   Health care legislation in Washington may be stalled, but that has not stopped  legislatures in more than two-thirds of the states from objecting to one of its central planks: a requirement that everyone buy health insurance.

The objections, many of them driven by the Tea Party movement, may turn out to be largely symbolic. But they nonetheless serve notice to President Obama and the Democrats of real anger over their health care plans and signal the potential for political upheaval down the road.

These measures, which are in various stages of ripening in about 36 states, could also pave the way for a major court challenge.

Following the Money on Health Reform

The blog digest known as Health Wonk Review is up with all the updates on how Massachusetts ruined health reform.  Also, lots of good stories following the money.

Take note of the Health News Review post on turf wars at the NIH consensus conference on colon cancer screening. Sounds ugly.

..There was scuffling over screening method vs. screening method, turf wars, and conflict of interest in the setting of guidelines or recommendations.

John Z. Ayanian, of the Department of Health Care Policy at Harvard Medical School spoke at the meeting on “Primary Care Practice and Health System Influences.”

Massachusetts: Push Back on Health Reform

More on the single-payer folks retrenching and talking about state-level change. This via email:

Last week Mass-Care joined over 100 activists, unions, legislators, and community organizations at a spirited organizing meeting in downtown Boston to launch a Massachusetts Campaign for Health Care Justice. Given the faltering efforts at national health reform, the campaign will attempt to organize a renewed push for Medicare-for-All legislation particularly at the state level, while building a mobilization network capable of supporting workers, patients, and communities struggling to maintain access to health care.

Did Mass Voters Reject the Massachusetts Health Reform Model?

Some Boston-area reform advocates see the apparent demise of the Senate health reform bill as a way to re-open discussion about single-payer and the high cost of premiums and co-pays for those buying insurance through the state.

Blogging for The New York Times, Steffie Woolhandler and David Himmelstein, the two Harvard docs at the front of the effort to promote single payer, say it is time.

The president can regain his footing by reconnecting with the hopes of Americans who elected him and rejecting the sordid corporate compromises that signify Washington politics as usual. A single-payer, Medicare-for-All reform would lower costs, cover the uninsured, and upgrade coverage for most insured Americans. Leading a crusade for such a plan, he’d mobilize vast popular support; enough to overwhelm Republican obstructionism. But instead, he seems intent on looking for light at the end of the same old tunnel.

During his campaign, President Obama declaimed that he’d back single payer – if we were starting from scratch. One thing’s clear from the recent Massachusetts election upset: it’s time to start from scratch.

Marcia Angell  suggest the same on HuffPo

Liberals are wrong to think that opposition to health reform is a rejection of big government. If health reform consisted of extending Medicare to everyone, people would be delighted.

Blue Mass Group points out that the California Senate just passed a Medicare for All bill.

Others say that one reason people dumped the Democrats is that they are having a hard time affording the premiums and co-pays that come with mandated insurance. From Trudy Lieberman in the 1/22 Columbia Journalism Review

Wednesday on WNYC’s Brian Lehrer Show, Richard Parker, who lectures at Harvard’s Kennedy School, talked about his son’s hockey coach, a third-generation Cambridge fireman who voted for Obama in 2008 but went for Brown this time. The fireman, like most public sector workers, has very good insurance—a so-called Cadillac plan with good benefits that the Washington health care cognoscenti want to tax into oblivion. “They’ll screw my system if we don’t stop them,” the coach told Parker. The anecdote raised an important question—how affordable will insurance be when national reform is fully enacted? Parker said that people in the state perceive national reform as all about expanding coverage, not affordability, which he called “the poison pill at the heart of the bill.”

Still, the possibility of a global payment system is on the table here in Mass and some advocates are lining up behind it. (Under the system, doctors and hospitals would be paid per episode – like a heart attack – or per patient. Now, they are paid for each service they deliver – hospital stay, anesthesia, specialist consults Reformers say the current system leads to much waste and unnecessary treatment.)

Health Care for All, a local group that supported the Obama plan, has set up a new organization to make sure patients have a role in that effort – The Massachusetts Campaign for Better Care

Payment reform can both improve the quality of health care and lower costs. Changing the payment system will not be easy, but we can get there through patient-centered care. To do this we need to reduce waste, give patients more control and free up doctors from time-consuming paperwork so they can be there for you…

Improving your care can drive down the price of health care. We need to make your co-pays and premiums more affordable so that everyone can get the care they need.

For more on the Mass proposal for global payments see:  The Recommendations of the Special Commission on the Health Care Payment System.

Obama in NH promises to push on with health reform

AP reports that at Obama’s health reform comments went over well at a stop in Nashua. That story and more from NPR. He was in NH to talk about a program to help small businesses.

He earned a standing ovation when he restated his goal of an ambitious remake of the nation’s health care system.

“We got to get it done,” Obama said as loud cheers and sustained applause drowned him out. “Let’s get it done this year.”

Kaiser Health News has a good roundup.

Video on the Boston Channel

Health Bill Left at the Altar?

So close, yet so far.

The Hill reports that the House and the Senate had a deal on the health  bill  ready to go days before the Massachusetts Senate election. They sent it to CBO. Then Brown won. And CBO didn’t even bother sending it back.

The latest revelation shows how agonizingly close Democrats came to passing a final healthcare bill in time for President Barack Obama’s State of the Union address.

Dr Paul Farmer on Fixing Haiti

1/27/2010 Paul Farmer of Partners in Health telling Congress what Haiti needs:

The relief efforts, focused now on addressing the initial wave of devastation from the earthquake, will soon turn to a new set of concerns. Hastily cobbled together camps are at risk of outbreaks of cholera and other waterborne disease. The Haitian government has wisely proposed avoiding huge camps, which will be difficult to manage, but we must hasten our efforts to get tents, tarpaulins, and latrines or composting toilets to Haiti. It is humbling to see the relief efforts be so slow—in large part because delivery of services was so weak before the quake. Now we must do more to get food and water to people every day for some time to come. Creating safe schools and safe hospitals, even makeshift ones, is a known need in rebuilding a society, and storm resistant housing must also be a carefully considered priority since there is little time before the rainy season. Students need to be back in school; the planting season cannot be missed and requires fertilizer, seeds, and tools.

No names in AG hospital cost report?

The Globe reports:

Massachusetts insurance companies pay some hospitals and doctors twice as much money as others for essentially the same patient care, according to a preliminary report by Attorney General Martha Coakley. It points to the market clout of the best-paid providers as a main driver of the state’s spiraling health care costs.

Which hospitals?

The report did not identify insurers and providers by name, and Coakley declined to release the names of the highest-paid, saying she wanted to lay out systemwide problems, not blame individual organizations

A good time to revisit the Globe series on Partners hospital system and its impact on costs.

And wasn’t that a former insurance executive who ad-walked across this story while I was reading it?

How to check out a nursing home

The reform debate has shrouded the other healthcare crisis – How to pay for and deliver long- term care. In the meantime, buyer beware. Here’s some help.

Medicare has a new searchable database on Nursing Home Quality.

USA Today has a story on it and their own version of the database.

One in five of the nation’s 15,700 nursing homes have consistently received poor ratings for overall quality, a USA TODAY analysis of new government data finds.

Massachusetts already has a database but the two above are easier to read.