HHS introduces new HIT czar

WASHINGTON – Just as this issue of Healthcare IT News was going to press, the Department of Health and Human Services introduced David Blumenthal, MD, as the Obama Administration’s new National Coordinator for Health Information Technology.

“I am humbled and honored to have the opportunity to serve President Obama and the American people in the effort to harness the power of health information technology,” Blumenthal said.

For up-to-the-minute coverage of Blumenthal’s appointment and industry reactions, please visit our Web site at
www.healthcareitnews.com.

Panasonic introduces medical-grade 3D monitor for surgery

SECAUCUS, NJ – Panasonic, a provider of professional healthcare display and monitor solutions, today announced a new 3D medical-grade 32” class monitor.

The new monitor, the EJ-MDA32U-K, is fully compliant with medical equipment standards, delivers 2D and 3D image quality and can display multiple images from various sources at once, according to Panasonic officials.

These combined features, paired with Panasonic’s renowned reliability, make the new monitor ideal for use in the surgical bubble, they said in a press release.

“To improve patient outcomes, there is an ever increasing reliance on technology in the surgical suite,” said Scott Thie, director of Healthcare, Panasonic System Communications Company of North America. “Although this technology has many benefits, it can also create a cluttered environment."

The EJ-MDA32U-K helps to improve the surgical experience by having a large screen, HD image that can be clearly viewed by all clinicians, while also providing flexibility that helps to reduce clutter, according to Thie. “By allowing up to three images to be displayed on the screen at once – from multiple input sources – and by delivering high quality 3D and 2D HD images, we offer a single device that addresses multiple needs in the surgical suite,” he said.

 [See also: Panasonic introduces 3D videoconferencing.]

Calling all innovators: Health 2.0 contest makes eHealth a priority

SAN FRANCISCO – On Wednesday, officials at the Office of the National Coordinator for Health Information Technology (ONC) and Health 2.0 announced the launch of a collaborative venture that aims to spur health information technology innovation among software developers. 

The Investing in Innovation (i2) Initiative competition seeks to foster the use of technology to drive improved health outcomes, officials say, driving patient participation in their own health and wellness data.  

The Health 2.0 Developer Challenge program is now accepting submissions for the new competition, the SMART-Indivo App Challenge. SMART (Substitutable Medical Apps, Reusable Technologies) is one of four Strategic Health IT Advanced Research Projects (SHARP) funded by the ONC. 

A healthcare system adapting to the effects of an aging population, growing expenditures and a diminishing primary care workforce needs the support of a flexible information infrastructure, officials say, which will ultimately facilitate innovation in wellness, health care and public health.

The SMART API challenge is a multidisciplinary call to IT innovators and software developers to create an Indivo application that provides value to patients using data delivered through the SMART API and its Indivo-specific extensions. The app will be either an HTML5 Web app or an iOS app that runs against the Indivo Developer Sandbox, where it can access patient demographics, medications, laboratory tests and diagnoses using Web standards.

Developers could, for example, build a medication manager, a health risk detector, a patient-friendly laboratory visualization tool or an app that integrates external data sources with patient records in real-time.

Officials say submissions will be evaluated on five parameters. These include: usefulness to patients, importance to clinical medicine or public health, interface and presentation, use of the Indivo and SMART APIs, and creative use of data from the sandbox and, optionally, from open health data sources. A review panel consisting of technical experts will evaluate the submissions.

Submissions are due on September 28, 2012. Prizes total $13,000, with the first place team awarded $10,000. The first place winner will also present the winning solution at a national conference. For more details visit the SMART-Indivo App Challenge website.

"Health 2.0 is excited to be launching this new challenge," said Indu Subaiya, CEO and co-chair of Health 2.0. "The SMART-Indivo App Challenge is an interesting competition that embraces key Health 2.0 themes, including modularity, scalability and interoperability. Applications developed for this challenge will help individuals to manage their health and wellness information across a range of healthcare settings."

Medicaid Expansion: Who's In? Who's Out?

Courtesy of the Center for American Progress

In the week since the Supreme Court upheld almost all of President Obama's health care law, some of the biggest action has been on the Medicaid front, where the administration definitely lost.

Until last week, the Affordable Care Act was expected to drive an expansion of Medicaid to the tune of about 17 million more people being covered over the next 10 years.

The Affordable Care Act, as written, would have required states to provide Medicaid coverage to adults, whether they have children or not, with incomes up to 133 percent of the federal poverty level.

Now that expansion is optional, and it's unclear how many uninsured people will ultimately gain coverage under the law.

 

Medicaid is paid for with a mix of state and federal funds. So a big expansion could get expensive for states, even though the federal government would kick in a lot of the extra dough.

"It's going to cost Florida $1.9 billion a year," Florida Republican Gov. Rick Scott said on CNBC's Squawk Box Monday. He said Florida wouldn't go along with it.

Scott's claim is too high, according to an independent analysis by Politifact, which put the cost of the additional Medicaid coverage at a little over $500 million a year. And most of those costs wouldn't pop up until 2020.

But five states, including Florida, have said they're out as of Thursday morning, according to The Daily Briefing from the Advisory Board Co.

Lots of states now offer Medicaid only to adults with children, and the income cutoff is generally much less generous, too.

The law says the feds could withhold all federal Medicaid funds from states that didn't comply. But the high court ruled that hammer was just too extreme.

A majority held:

"The threatened loss of over 10 percent of a State's overall budget is economic dragooning that leaves the States with no real option but to acquiesce in the Medicaid expansion."

So the states can skip of the expansion and only miss out on those federal funds that would have gone toward it.

The interactive chart from the Center for American Progress, embedded above with its permission, shows what's at stake. Hover over a state to see how many people could be affected.

As Julie Rovner reported last week, many low-income people who don't qualify for Medicaid now won't be eligible to for the next best alternative, a tax credit to subsidize the purchase of health insurance through a state exchanges.

Rovner is taking another look at how the Medicaid choices are unfolding. Stay tuned.

State Legislatures Stay Busy On Abortion Laws

Enlarge Steve Helber/AP

Virginia Senate Republican Leader Thomas Norment, of James City, (left), and State Sen. Stephen Newman, of Lynchburg, listen to a Feb. debate on a bill requiring an ultrasound before an abortion. The bill was later amended to remove a requirement for transvaginal ultrasound.

Steve Helber/AP

Virginia Senate Republican Leader Thomas Norment, of James City, (left), and State Sen. Stephen Newman, of Lynchburg, listen to a Feb. debate on a bill requiring an ultrasound before an abortion. The bill was later amended to remove a requirement for transvaginal ultrasound.

2011 was a banner year for state laws restricting abortion. And 2012 looks like runner-up.

That's the central finding of the midyear report from the Guttmacher Institute, the reproductive policy research group that keeps track of such things.

There were 39 laws restricting abortion enacted in the first half of 2012. While that's less than half the 80 put in place during the first half of last year, the number of laws already on the books for 2012 is higher than any other year before 2011.

Among the popular targets this year are:

  Restrictions on medication abortions (passed by three states); Banning abortion prior to fetal viability (also passed by three states); and, Limiting coverage of abortion by insurance policies participating in health exchanges that will sell policies under the new health law starting in 2014 (passed by four states).

And while some bills that got a lot of attention didn't pass �- such as ones to ban abortion beginning when a fetal heartbeat can be detected in Ohio, or one requiring a transvaginal ultrasound in Virginia � remarkably similar ones did make it through in other states with far less fanfare.

It seems a new law inLouisiana that requires abortion providers to make the fetal heartbeat audible to women seeking an abortion necessitates a transvaginal ultrasound for many first trimester procedures. One in Oklahoma requires that women be given the opportunity to hear a fetal heartbeat before the procedure.

Guttmacher researchers suggest a few reasons for the slightly slower pace. "Election year sessions tend to be shorter, and focus more and bread-and butter issues, as opposed to social issues," they wrote. "In addition, mirroring the situation nationally, legislatures in states such as New Hampshire and Indiana appear to be in near-total gridlock, seeming able to tackle only 'essential' issue relating to spending and basic state services."

Health Care Reform: We’re Not Done Yet

The Supreme Court has spoken. The Affordable Care Act, briefly on the ropes, has been blessed as the law of the land.

Too many feel that health reform is finally finished and we can move on to the big three issues: the economy, jobs and the deficit. However, because health care is the 800-pound gorilla of the economy, those issues cannot be solved without more far-reaching health reform.

Sorry, lawmakers, but you are going to need to get back in the ring to answer a fundamental question: what is the most cost-effective and constitutional way to finance health care so that we can have quality, affordable health care for everyone?

The answer � single-payer national health insurance, also known as an improved Medicare for all � would save America hundreds of billions of dollars annually. And as the Supreme Court reaffirmed, a program of this type, financed by taxes, is definitely constitutional.

Outrageously, this simple solution was never discussed in the two contentious years of debate surrounding the creation of the ACA because it was deemed �politically impossible.�

�Politically impossible� means that the mere utterance of �single payer� would be enough to prompt the medical-industrial complex, especially the pharmaceutical and insurance industries, to funnel millions of dollars in campaign contributions and lobbying money to opponents of real reform and to tea party groups in order to keep the status quo.

So America continues to promote the least cost-effective way of financing health care, which means that we spend twice per capita on health care than any other nation on earth.

When we were the global leader as we were back in the mid-20th century, we could afford to do this. However, we cannot afford our health care system anymore. It is hopelessly complex, bureaucratic, and outrageously expensive. Employers have shifted the cost to employees and it will only get worse as private insurers raise their premiums.

Beyond skyrocketing premiums, about 18 percent of our gross national product is consumed by health care. That figure will rise to 20 percent by the end of the decade. In order to fund this inefficient system, we have borrowed trillions of dollars over the past 50 years, transforming us into the world�s greatest debtor nation.

No matter who wins the November election, the next administration will be forced to confront the deficit. Unfortunately, it appears that our lawmakers� tunnel vision only offers slashing Social Security, Medicaid and Medicare for the poor and elderly as a way to reduce government spending. That course would be catastrophic.

No one seems to want to confront the fact that unless we are willing to embrace an improved Medicare for all, with its streamlined administration and bargaining clout, we have no hope of controlling health care costs, ensuring that our country will remain in debt. Had we adopted a single-payer system 20 years ago, we would have turned our national debt into a surplus today.

In a global economy, employers have to add the cost of health insurance to every product or service. When that cost is twice what the world spends, it eventually means that we are pricing our products too high. Manufacturers have moved their major factories overseas because of lower labor costs, of which health insurance is a key component.

Entrepreneurs are everywhere in America, but too many are locked into undesirable jobs because they need the health benefits. Those who want to put their toe into the self-employed world stop because of the risk of losing health benefits which is bad for an economy that needs creativity and risk.

State and local governments are being weighed down by pension obligations and retiree health benefits. Under a single-payer system, Philadelphia could be freed from the unpredictability of these costs and use those precious dollars for our schools, streets, or public safety.

An ABC/Washington Post poll shows that less than 40 percent of Americans view the ACA or the status quo favorably � remarkably low for a �uniquely American� solution.

Our politics have robbed us from even discussing a practical, commonsense solution � improved Medicare for all — that we desperately need in America. If the medical-industrial complex continues to win, health care costs will continue to rise, and the American people will be the losers.

Dr. Walter Tsou is former health commissioner of Philadelphia. He is a board adviser to Physicians for a National Health Program (www.pnhp.org) and resides in Philadelphia.

Even known food allergens dangerous for kids

Even when parents and caregivers are aware of infants' food allergies and have been instructed in avoiding potentially dangerous trigger foods, allergic reactions still occur, the result of both accidental and non-accidental exposures, a study finds.

Accidental exposures from unintentional ingestion, label-reading errors and cross-contamination resulted in 87% of 834 allergic reactions to milk, eggs or peanuts in the study, reported in today's Pediatrics.

Non-accidental exposures resulted in 13% of reactions. It's not clear why caregivers would purposely give a child a known allergen, maybe "to see if (the child) has outgrown an allergy, or how allergic he is," says lead author David Fleischer, a pediatric allergist at National Jewish Health in Denver.

Fleischer and colleagues analyzed data from 512 infants, ages 3 months to 15 months, diagnosed with or at risk for having an allergy to milk, eggs or peanuts. In a 36-month period, 72% had at least one reaction; 53% had more than one.

"This is a high rate of reactions and concerning," says Fleischer, noting that parents were counseled "on a regular basis about food avoidance."

Only 50% of the accidental reactions were from food provided by parents, highlighting the importance of educating all caregivers � grandparents, siblings, babysitters and teachers � about food allergies, he says.

"There is still some misunderstanding in the general public about food allergy and how serious it can be," says Ruchi Gupta, an associate professor of pediatrics at Northwestern University. She led a study published last year that found 8% of U.S. children younger than 18 have a food allergy. About 40% had experienced a life-threatening reaction, such as blocked airways or a drop in blood pressure.

Concerns that skin contact or inhalation might trigger severe reactions were not supported by the new study, Fleischer says. "The vast majority happened from ingestion."

Only 30% of severe allergic reactions were appropriately treated with an epinephrine injection, even when caregivers said they felt that was warranted. Epinephrine helps stop reactions by relaxing muscles in the airways and tightening blood vessels.

There's often a "fear of using epinephrine, a concern that there will be side effects," Fleischer says. "In studies that we've done, parents are surprised how quickly and effectively it works."

Omnicell acquires MTS for $156M

MOUNTAIN VIEW, CA – Omnicell, the medication and supply management firm, has completed its acquisition of St. Petersburg, Fla.-based MTS Medication Technologies, which develops medication adherence packaging systems.
 
First announced May 2, the $156 million acquisition is aimed toward emerging accountable care organizations (ACOs) and will see Omnicell and MTS working to integrate medication management across the broader spectrum of care.
 
MTS serves 6,000 pharmacies worldwide, providing automated packaging systems designed to help solve the critical problem of medication non-adherence. This issue has been estimated to cost up to $290 billion annually and is blamed for some 125,000 deaths per year. The Centers for Medicare & Medicaid Services (CMS) estimates that 11 percent of all hospital admissions are related to this issue.
 
“We believe that the addition of MTS to the existing Omnicell solutions uniquely positions Omnicell in the industry to supply the new demands for tracking and managing treatment beyond the acute care setting and use these capabilities to cut costs and improve outcomes," said Randall Lipps, chairman, president and CEO of Omnicell.

MTS’s medication management technology is used by institutional pharmacy providers to supply long-term and non-acute care facilities with single-dose, 30-day blister card medication packages to help nurses adhere to prescribed orders. In addition to single-dose solutions, MTS develops multi-dose adherence packages that help patients and caregivers in the home to manage medication administration, by providing all the doses required at a single administration time in a single package.
 
“Increasingly, health systems have strong financial and patient satisfaction incentives to actively work to reduce hospital readmissions, and medication adherence is a key component," said Lipps. "With the addition of MTS, Omnicell is in a stronger-than-ever position to partner with healthcare organizations across the full continuum of patient care delivery."

The merger, he said, helps Omnicell address the "costly, critical issue of non-adherence head-on, through medication packaging solutions and consumables that help patients and caregivers adhere to the prescribed medication regimen. We believe the new end-to-end Omnicell portfolio of innovations brings unmatched value to safe, effective medication management for healthcare organizations in both acute and non-acute care environments.”

“MTS brings to Omnicell 28 years of leadership in long-term care, a growing presence in international retail markets and deep expertise in the manufacturing of consumables to support these customers," he said. "Omnicell has unique expertise in capital equipment and software for medication and supply management in the acute care market. Together, we will advance Omnicell’s strategy to offer hospitals and non-acute healthcare providers alike the leading solutions to improve patient safety, clinical outcomes and healthcare delivery economics.”

MTS Medication Technologies will continue to operate under that brand, as a wholly-owned subsidiary of Omnicell.

U.S. vets' disability filings reach historic rate

America's newest veterans are filing for disability benefits at a historic rate, claiming to be the most medically and mentally troubled generation of former troops the nation has ever seen.

A staggering 45% of the 1.6 million veterans from the wars in Iraq and Afghanistan are now seeking compensation for injuries they say are service-related. That is more than double the estimate of 21% who filed such claims after the Gulf War in the early 1990s, top government officials told the Associated Press.

What's more, these new veterans are claiming eight to nine ailments on average, and the most recent ones over the last year are claiming 11 to 14. By comparison, Vietnam veterans are currently receiving compensation for fewer than four, on average, and those from World War II and Korea just two.

It's unclear how much worse off these new veterans are than their predecessors. Many factors are driving the dramatic increase in claims � the weak economy, more troops surviving wounds, and more awareness of problems such as concussions and post-traumatic stress disorder (PTSD). Almost one-third have been granted disability so far.

Government officials and some veterans' advocates say that veterans who might have been able to work with certain disabilities may be more inclined to seek benefits now because they lost jobs or can't find any. Aggressive outreach and advocacy efforts also have brought more veterans into the system, which must evaluate each claim to see if it is war-related. Payments range from $127 a month for a 10% disability to $2,769 for a full one.

As the U.S. commemorates the more than 6,400 troops who died in post-Sept. 11, 2001 wars, the problems of those who survived also draw attention. These new veterans are seeking a level of help the government did not anticipate, and for which there is no special fund set aside to pay.

The Department of Veterans Affairs is mired in backlogged claims, but "our mission is to take care of whatever the population is," says Allison Hickey, the VA's undersecretary for benefits. "We want them to have what their entitlement is."

The 21% who filed claims in previous wars is Hickey's estimate of an average for the 1990-91 Operation Desert Storm and Desert Shield to oust Iraqi troops from Kuwait. The VA has details only on the current disability claims being paid to veterans of each war.

The AP spent three months reviewing records and talking with doctors, government officials and former troops to take stock of the new veterans. They are different in many ways from those who fought before them.

More are from the Reserves and National Guard� 28% of those filing disability claims � rather than career military. Reserves and National Guard made up a greater percentage of troops in these wars than they did in previous ones. About 31% of Guard/Reserve new veterans have filed claims, compared with 56% of career military ones.

More of the new veterans are women, accounting for 12% of those who have sought care through the VA. Women also served in greater numbers in these wars than in the past. Some female veterans are claiming PTSD because of military sexual trauma � a new challenge from a disability rating standpoint, Hickey says.

The new veterans have different types of injuries than previous veterans did. That's partly because improvised bombs have been the main weapon and because body armor and improved battlefield care allowed many of them to survive wounds that in past wars proved fatal.

"They're being kept alive at unprecedented rates," says David Cifu, the VA's medical rehabilitation chief. More than 95% of troops wounded in Iraq and Afghanistan have survived.

Larry Bailey II of Zion, Ill., north of Chicago, is an example. The 26-year-old Marine remembers flying into the air, then fellow troops attending to him, after he tripped a rooftop bomb in Afghanistan last June. He ended up a triple amputee.

"I pretty much knew that my legs were gone. My left hand, from what I remember I still had three fingers on it," although they didn't seem right, Bailey said.

He is still transitioning from active duty and is not yet a veteran.

A look at the numbers

Of those who have sought VA care:

� More than 1,600 of them lost a limb; many others lost fingers or toes.

� At least 156 are blind, and thousands of others have impaired vision.

� More than 177,000 have hearing loss, and more than 350,000 report tinnitus � noise or ringing in the ears.

� Thousands are disfigured, as many as 200 of them so badly that they may need face transplants. One-quarter of battlefield injuries requiring evacuation included wounds to the face or jaw, one study found.

"The numbers are pretty staggering," says Bohdan Pomahac, a surgeon at Brigham and Women's Hospital in Boston who has done four face transplants on non-military patients and expects to start doing them soon on veterans.

Others have invisible wounds. More than 400,000 of these new veterans have been treated by the VA for a mental health problem, most commonly PTSD.

Tens of thousands of veterans suffered traumatic brain injury, or TBI � mostly mild concussions from bomb blasts � and doctors don't know what's in store for them long-term. Cifu, of the VA, says that roughly 20% of active-duty troops suffered concussions, but only one-third of them have symptoms lasting beyond a few months.

That's still a big number, and "it's very rare that someone has just a single concussion," says David Hovda, director of the UCLA Brain Injury Research Center. Suffering multiple concussions, or one soon after another, raises the risk of long-term problems. A brain injury also makes the brain more susceptible to PTSD, he says.

Body armor takes a toll, too

On a more mundane level, many new veterans have back, shoulder and knee problems, aggravated by carrying heavy packs and wearing the body armor that helped keep them alive. One recent study found that 19% required orthopedic surgery consultations and 4% needed surgery after returning from combat.

All of this adds up to more disability claims, which for years have been coming in faster than the government can handle them. The average wait to get a new one processed grows longer each month and is now about eight months � time that a frustrated, injured veteran might spend with no income.

More than 560,000 veterans from all wars currently have claims that are backlogged � older than 125 days. The VA's benefits chief, Hickey, says the backlog is the result of sheer volume, the high number of ailments per claim, and a new mandate to do oldest cases first.

With any war, the cost of caring for veterans rises for several decades and peaks 30 to 40 years later, when diseases of aging are more common, says Harvard economist Linda Bilmes. She estimates the health care and disability costs of the recent wars at $600 billion to $900 billion.

"This is a huge number, and there's no money set aside," she says. "Unless we take steps now into some kind of fund that will grow over time, it's very plausible many people will feel we can't afford these benefits we overpromised."

Doctors Have Trouble Keeping Up With Painkiller Abusers

Sue Ogrocki/AP

A pharmacy technician counts generic Vicodin tablets at Oklahoma Hospital Discount Pharmacy in Edmond, Okla.

The growing awareness about the abuse of prescription painkillers hasn't kept the problem from skyrocketing. In 2008, 14,800 people died of an overdose, according to the Centers for Disease Control and Prevention, more than overdose deaths from cocaine and heroin combined.

Prescription drug monitoring programs that allow doctors to track who's prescribing and dispensing powerful painkillers, such as OxyContin and Vicodin, can help curb patients' so-called doctor shopping. That's when people go to lots of doctors to load up on painkiller prescriptions.

But the databases for checking up on patients only work if health care providers use them, and often that's not happening. Some insurers are taking matters into their own hands, including a big one in Massachusetts that will soon make doctors justify prescriptions for pain pills that exceed a 30-day supply.

More than 40 states have systems in place to monitor prescription drugs, according to the National Alliance for Model State Drug Laws. Typically, dispensing data from pharmacies is uploaded into a centralized database that physicians and other health care providers can query.

 

But the programs are voluntary, and many clinicians remain unaware of them, according to a recent article published in the New England Journal of Medicine.

There are other difficulties. The data may only be updated once a month. And the systems are often cumbersome to use, a sticking point for busy clinicians.

Utah anesthesiologist Perry Fine, a past president of the American Academy of Pain Medicine, says that it's in patients' best interest that their doctors know which drugs they're taking to ensure proper treatment.

The database in Utah is pretty easy to use, he says. But in many states, that's not the case. "Because they're not very functional or accessible or complete, overall utilization hasn't been very great," he says. As the state systems evolve, that may change, but for now, "They're not mainstream."

And the drug-monitoring systems in some states, such as California, have suffered from cuts in funding.

Still, there's traction in other states. New York Gov. Andrew Cuomo is expected to sign legislation that would require doctors in the state to prescribe drugs using computers rather than paper, the Associated Press reported. Pharmacists would be required to promptly enter information about painkiller prescriptions into a statewide database, too.

Healthcare in the USA Pt. 2

Despite the fact the US continues to rank poorly in worldwide health care standards, John McCain like many, maintains that the United States health care is the best in the world.

The Real News Network spoke to Steven Lewis, health policy and research consultant from Canada, Dr. Don McCanne of Physicians for a National Health Program, and Dr. Steffie Woolhandler from the Harvard Medical School. Comparisons with other countries on costs and quality still leave the United States low in health care standards amongst rich industrialized nations.

Senate negotiations may drop healthcare IT grant funding from $5B to $3B

WASHINGTON – Senate wrangling over the weekend on a proposed $900 billion economic stimulus package has led to a $3 billion cut in proposed healthcare IT discretionary funding.

The Senate had been looking at spending $22 billion to $23 billion for healthcare information technology in the economic recovery package – including $5 billion originally allotted for funding that could include grants for providers to purchase healthcare IT.

Over the weekend, however, $2 billion was cut for healthcare IT federal discretionary funding.

The Senate says it may have the three Republican votes needed to pass its version of the stimulus package, but insiders say negotiations will be fierce before an expected final vote on Tuesday – and chances for passage may lessen the longer a vote is postponed.

Republican Sens. Susan Collins and Olympia J. Snowe of Maine and Arlen Specter of Pennsylvania have indicated they are likely to support the trimmed version of the Senate stimulus package, according to (italics) CQ Daily. (end italics)

Healthcare IT privacy activists are lobbying hard for privacy measures to be included in the package. "Privacy and security protections have to be meaningful and comprehensive or electronic health systems will never be trusted," said Deborah Peel, founder of Patient Privacy Rights.

Once the Senate passes its version of a stimulus package, it must be reconciled with the House version before it can be signed into law.

President Barack Obama hopes to have a bill passed before Feb. 13.

Do you know what you pay for health insurance?

A disturbing survey reveals that most Californians � and likely most Americans � are unwilling to focus on the details of their health coverage. Those who are focused on the details are finding their coverage is increasingly riddled with holes.

Health care consumers say their medical costs are going up and expect them to continue to rise. But people are unlikely to ask about cost before getting care. And many don't even know how much they pay for coverage or what their deductible is.

That's according to a recent survey of Californians, and likely applies to most Americans. It's an odd disconnect that people are aware that costs are going up and likely to continue (73 percent thought so), but that many folks are unwilling to focus on the details of their coverage.

Maybe that's understandable, given how difficult it can be to sort out premiums from deductibles from copays, and how often those change from year to year.

Most Americans still get their insurance coverage from an employer, and we like to think that we're taken care of � that if we have a job and a health plan we're all set. What increasing numbers of people are learning is that there are holes in the system even if we have coverage. In this survey from the California HealthCare Foundation, 39 percent of those whose costs went up in the past year said their benefits got worse at the same time.

Those trends are not news for people buying insurance for themselves on the individual market, where high deductibles and Swiss-cheese coverage are the norm. Of those whose costs had risen, 61 percent were in the individual market.

So, the likelihood that your health plan is getting more expensive and/or less comprehensive is fairly decent, and would seem to provide plenty of incentive to educate yourself about your coverage. And yet just 26 percent of those surveyed tried to get information about the cost of a test, treatment or other type of health service before receiving it. Doing research was more likely among those with a high deductible (the amount of money you pay before insurance kicks in).

More evidence that American consumers are practicing avoidance: Among the half of survey respondents who knew they had a deductible, nearly half didn't know the amount. A third didn't know what their premium was or wouldn't answer the question.

These are troubling statistics given the brave new world of insurance coverage we're living in, one that assumes consumers are shopping for health coverage and medical services just like they do other big-ticket items like cars. But there aren't many people who don't know how much their car payment is.

New Report: Health Care Law Saves Money for Consumers

Today, 11 million Americans buy health insurance on their own, without the help of an employer, Medicare or Medicaid. Too often, these people pay more money but get fewer benefits than people who have insurance through their employer. What�s more, people in the individual market have higher out-of-pocket costs, including larger deductibles and copays, and a lower likelihood of having prescription drug coverage.

And yet, these individuals are the ones who have been lucky enough not to have been turned away because insurance companies have denied them coverage because of health status or a pre-existing condition. The new health care law has already prohibited discriminating against children because of a pre-existing condition and prohibits the practice with respect to all Americans beginning in 2014.

A new study released today shows that the Affordable Care Act will help people in the individual health insurance market even more. In 2014, individual health insurance is likely to be more generous and more similar to employer-based coverage. And this means Americans will save money. The study compared how much people in the individual market would have saved in out-of-pocket spending alone, had the Affordable Care Act already been implemented.

It found that if adults in the individual market during 2001-08 had benefits similar to those provided under the Affordable Care Act, they would have seen:

An average annual savings of $280 in annual out-of-pocket spending for medical care and drugs,Average out-of-pocket savings of $589 for those 55-64 and $535 for those 26-64 with low incomes, respectively, andNear elimination of out-of-pocket expenses over $6,000 for all adults and a reduced likelihood of those expenses over $4,000.

This study highlights just one way the Affordable Care Act will save Americans money, and ensure they get high-quality health care.

How will this happen? Under the Affordable Care Act, there will be a new marketplace�known as Affordable Insurance Exchanges�for individuals to buy health insurance. Exchanges allow consumers to easily compare and purchase affordable, high quality health insurance and require insurance plans to compete on a level playing field. That kind of competition drives costs down for consumers. Additionally, eligible Americans purchasing coverage through Exchanges will have essential health benefits, an annual out-of-pocket limit on coverage, and access to premium tax credits � a benefit not taken into account under this study.

The Affordable Care Act makes other important changes to make the health insurance market work better for Americans. Changes include:

Getting rid of lifetime limits and phasing out annual dollar limits on most benefits,Setting a minimum medical loss ratio or 80/20 rule for insurers, generally requiring rebates if less than 80 percent of premiums are spent on health care and quality, andLowering out-of-pocket spending limits even further for low-income Americans.

For other ways the Affordable Care Act benefits Americans, visit this page.

The article, �Individual Insurance Benefits to be Available under Health Reform Would Have Cut Out-Of-Pocket Spending in 2001 - 08� is available at: http://content.healthaffairs.org/content/early/2012/05/11/hlthaff.2011.1206

PayerView rankings show performance stuck in place

WATERTOWN, MA – Payer performance improvement remained flat in 2011, according to the seventh annual PayerView rankings released today by health IT company athenahealth. That's attributed in part to new compliance measures and major information technology shifts.

Though they did not perform as well as 2010, Humana and Aetna remained top performers, and UnitedHealthcare led the national payers.

[See also: Humana named top payer in athenahealth's annual study]

It’s the first time since 2008 that payers have not boosted performance, said Patricia Andriolo-Bull, vice president of payer business development for athenahealth. “We do believe that there is a point of saturation so it becomes harder as time goes on to get better.”

Andriolo Bull said over the next three to five years, she expects the different aspects of health reform will affect both payers and consumers. With the increased purchase of high-deductible health plants, she said, patient co-pays are likely to increase, and there will be more pressure to collect upfront.

The PayerView project employs aggregate claims data made available through athenahealth’s cloud-based network of 33,000 providers to analyze insurance payer performance and to provide an objective, quantitative measure of providers' "ease of doing business" with individual payers.

[See also: Aetna 'best performer' in athenahealth's annual ranking]

The resulting data helps foster an industry-wide dialogue on how breakdowns in the medical claims billing process can be addressed. Complete rankings and correlating trends can be found at athenahealth.com/PayerView.

At a high level, PayerView revealed that in 2011 insurance payer performance remained flat, and in some cases reversed, with regards to getting physicians paid promptly and without excessive work.

While on the surface the data suggests comparative under-performance, a deeper dive suggests payers were challenged with major information technology shifts and new compliance obligations that affected not only the payers, but all of their trading partners as well.

Data on claims resolution and denials exposed the first signs of supply chain disruption from conversion to ANSI 5010, presaging difficulties that may lie ahead with the changeover to ICD-10. As a result, in the midst of grappling with these industry changes and meaningful use, physicians were forced to take on more of the work and hassle of collecting patient payments without any benefit of improved operational efficiency.

“While we speculate that market forces around the transition to ANSI 5010 are at least partially responsible for insurance payer performance, it’s less clear what role resources put against reform, or put on hold, may have played,” said Jonathan Bush, chairman and CEO of athenahealth. “We found that for major payers and Medicare, days in accounts receivable and first pass resolution rate both slipped slightly, signaling the beginning of the 5010 transition. The question might be asked: ‘With this degree of impact on performance prior to the 5010 transition ... what can providers expect with the transition to ICD-10?’”

Resources previously aimed at reimbursement performance appear to have been re-appropriated in 2011 as payers focused resources on addressing ANSI 5010, Bush said. As conversions to 5010 only just began in earnest in late 2011, the expectation is that performance in 2012 will stagnate or decline as well.

Other key findings:Medicaid was the only group to show improvement in DAR rates (albeit less in 2011) but is still about 20 days higher than the weighted averages of the other groups.The transference of collection from the payer to the next responsible party further squeezes the viability of independent practices. Also, with consumers footing more of the bill, the physician is forced into a reluctant role as collection agent, potentially compromising the physician-patient relationship. Provider collection burdens have continued to increase from 2010 to 2011 (a 7 percent  lift from 16.7 to 17.8 percentage points) among all payers.The Blues slowed collection burden rates considerably between 2010 and 2011.The rankings also revealed certain geographic disparities with regard to provider collection burden rates: At 17.7 percent, the Northeast had the lowest overall amount transferred to the next party. At 23.5 percent, the West ranked highest in terms of collection burden transfer.

Continued on next page.

New app maps patients' health risks

WASHINGTON – IndiGO, an application developed by San Francisco-based Archimedes Inc., uses a patient's EHR and advanced algorithms to generate graphical analyses of that individual's health risks. The app brought its game face to last week's Health Data Initiative (HDI) in Washington, D.C., eventually walking away with a win.

IndiGO was presented with the "Best of Care Applications" award at the HDI event earlier this month for its ability to provide a graphical representation of a patient’s heart attack or stroke risk, chance of developing diabetes and the predicted impact of interventions, such as lifestyle changes and medications that are most effective at reducing these risks.

The algorithms that make this possible incorporate clinical evidence related to diseases, behaviors and interventions. IndiGO and individualized guidelines can be used at the point-of-patient care, involving the patient in the decision-making process and improving collaboration between patient and provider. IndiGO is designed for use within ACOs, medical groups, integrated delivery networks (IDN), independent practice associations (IPA) and patient-centered medical homes (PCMH).

"The 'Best of Care Applications' award for IndiGO represents further recognition of the value of clinical decision support, delivered at the point of patient care," said Josh Adler, vice president of Archimedes and IndiGO business leader. "IndiGO's unique capabilities, in the hands of our physician partners, have been found to drive better patient engagement and increase adherence, leading to improved outcomes and lower costs."

The HDI, now guided by the Health Data Consortium, encourages innovators to utilize health data to develop applications to raise awareness of health and health system performance, and spark community action to improve health. Archimedes was one of 17 companies, chosen by a panel of judges from among more than 200 contending companies, to present during the main stage session at Health Datapalooza.

Bloodhound Technology's ConVergence Point refines the payment process

DURHAM, NC – Imagine a medical bill that can be accurately rendered before the patient leaves the doctor's office.

Bloodhound Technologies is working toward that ideal with ConVergence Point, its newly released claims editing platform that aims to process single or multiple claims against a patient's history, complete payer policy customizations and millions of sourced clinical edits in less than a second.

"This allows us to take a process that used to be in the claims transaction system ... and move it up to the front," said Gary Twigg, CEO and president of the Durham, N.C.-based claims editing services and analytics provider. "It's more robust, more sophisticated."

"The technology now exists to have a completely adjudicated claim even before the patient leaves the office," he added. "That's in the future. We'll be there someday."

Developed with $14 million in financing, ConVergence Point draws upon a patient's complete medical history, payer rules and reimbursement policies and Bloodhound's 16 million sourced clinical edits to process claims in 350 milliseconds. The company also offers a pre-adjudication editing platform, allowing providers to identify operational efficiencies as well as identify overpayments and correct miscoded claims before submission. 

Among the beta-testers for ConVergence Point was Senior Whole Health, a voluntary healthcare plan for low-income seniors in Massachusetts and New York.

"From the get-go, Bloodhound Technologies was able to take our data and immediately respond with a comprehensive analysis," said Mike Levoshko, the group's CTO, in a press release prepared by Bloodhound.  "What's more, ConVergence Point is a three-dimensional system that lets you turn its edit rules on and off at any point. The fact that ConVergence Point can control and archive these rules dynamically is worth its weight in gold."

Twigg says ConVergence Point should not only help providers and their patients establish a proper medical bill in real time, but improve communications between providers and payers.

"Real time adjudication processes are important to support the emerging consumerism market, providing clear payment liability information to both providers and consumers," said Janice Young, program manager for payer research with Health Industry Insights. "Solutions that improve the consistency, transparency and timeliness of claims processing deliver a new level of accuracy that will lead to improved relationships among payers, providers and consumers."

Medical students embrace Medicare for all

If you ever want to rekindle your hope for American medicine, spend time with medical students. These bright, energetic minds are going into medicine for all the right reasons � to help people, relieve suffering and find new ways to cure illness and eradicate disease.

Their idealism is a pleasure to behold, particularly to a veteran physician like me. Yet I’m painfully aware of how our current health care ‘system” can undermine students’ idealism, especially if they see no alternative.

Fortunately, a better alternative is waiting in the wings: a single-payer, improved Medicare-for-all program. Most Americans, including 59 percent of physicians, want access to an improved Medicare. I’m pleased to report that our physicians-in-training are strong supporters of this truly universal, comprehensive and affordable alternative.

Why? Even before they graduate, today’s medical students learn how our Byzantine, antiquated system of patchwork private insurance undermines medical care. They recognize an imperative to correct social injustice, for both moral and pragmatic reasons.

Medical students learn that as practicing doctors they’ll be dealing with dozens of different insurance schemes, each with its own rules, paperwork and bureaucratic headaches.

As physicians-in-training, they encounter patients who have delayed surgery until they qualified for Medicare at age 65 � often with more difficult and sometimes fatal complications as a result. They meet grandmothers who have had to decide between paying for medications for their hypertension and paying the rent.

They see patients with employer-sponsored health insurance get sick, lose their job, lose their insurance and declare bankruptcy. In fact, medical expenses are the most common cause of bankruptcy.

Like everyone else, medical students are shocked when they see these inequities and inefficiencies. They believe your wealth should not determine your health and that poor health should not be able to destroy your wealth. And, of course, they’re right.

I recently had a chance to discuss these issues with students at both of the major medical schools in town. Just last month the new St. Louis chapter of Physicians for a National Health Program brought in Dr. Garrett Adams, PNHP’s national president, and Dr. Carol Paris, a single-payer advocate from Maryland, to speak with students at those schools.

The sessions were co-sponsored by the American Medical Student Association, a long-standing supporter of a single-payer system that has about 30,000 members nationwide.

It was clear from our local meetings that growing numbers of our medical students reject our dysfunctional, insurance-based system. They want something better. Many understand there is a breathtakingly simple solution: fix the limitations in Medicare and provide it to every American. More than 30 percent of the health care dollar today is wasted on the administrative costs associated with the private health insurance industry; Medicare spent only 1.5 percent on administrative costs during 2011.

A landmark study in the New England Journal of Medicine (2003) showed that by replacing our fragmented, inefficient patchwork of multiple insurers with a single, streamlined, nonprofit agency like Medicare that pays all medical bills, our nation would save about $400 billion annually in reduced administrative costs � enough money to provide comprehensive, high-quality coverage to every American for no more than our nation spends now.

According to Gerald Friedman, professor of economics at the University of Massachusetts-Amherst in the March/April 2012 issue of Dollars and Sense, “a single-payer system would save as much as $570 billion now wasted on administrative overhead and monopoly profits.” Spending would increase by $326 billion from expanding coverage and adjusting Medicaid rates. Americans would net a savings of $244 billion, enjoy universal coverage and eliminate the dreadful scenarios described above. Disposable income would increase for 95 percent of Americans.

Because a single-payer system would possess enormous bargaining clout, it also would be able to rein in costs for pharmaceutical drugs and other medical supplies over the long haul.

I believe that adopting an “improved and expanded Medicare for all” is the best way for students and physicians to return to their mission of caring for our patients, rather than squandering our time navigating administrative barriers erected by insurance companies. And make no mistake � these are barriers to care, with dire consequences.

Although we spend more on health care per capita than any other country in the world, American life expectancy ranks 38th.

My colleagues and I came away from our student meetings confident that the future of medicine is in good hands. The medical students we met didn’t get lost in jaded political quagmires.

They know it’s inevitable. They just want it to happen now.

Me too.

Dr. Ed Weisbart is chairman of Physicians for a National Health Program�St. Louis.

Medical students embrace Medicare for all

If you ever want to rekindle your hope for American medicine, spend time with medical students. These bright, energetic minds are going into medicine for all the right reasons � to help people, relieve suffering and find new ways to cure illness and eradicate disease.

Their idealism is a pleasure to behold, particularly to a veteran physician like me. Yet I’m painfully aware of how our current health care ‘system” can undermine students’ idealism, especially if they see no alternative.

Fortunately, a better alternative is waiting in the wings: a single-payer, improved Medicare-for-all program. Most Americans, including 59 percent of physicians, want access to an improved Medicare. I’m pleased to report that our physicians-in-training are strong supporters of this truly universal, comprehensive and affordable alternative.

Why? Even before they graduate, today’s medical students learn how our Byzantine, antiquated system of patchwork private insurance undermines medical care. They recognize an imperative to correct social injustice, for both moral and pragmatic reasons.

Medical students learn that as practicing doctors they’ll be dealing with dozens of different insurance schemes, each with its own rules, paperwork and bureaucratic headaches.

As physicians-in-training, they encounter patients who have delayed surgery until they qualified for Medicare at age 65 � often with more difficult and sometimes fatal complications as a result. They meet grandmothers who have had to decide between paying for medications for their hypertension and paying the rent.

They see patients with employer-sponsored health insurance get sick, lose their job, lose their insurance and declare bankruptcy. In fact, medical expenses are the most common cause of bankruptcy.

Like everyone else, medical students are shocked when they see these inequities and inefficiencies. They believe your wealth should not determine your health and that poor health should not be able to destroy your wealth. And, of course, they’re right.

I recently had a chance to discuss these issues with students at both of the major medical schools in town. Just last month the new St. Louis chapter of Physicians for a National Health Program brought in Dr. Garrett Adams, PNHP’s national president, and Dr. Carol Paris, a single-payer advocate from Maryland, to speak with students at those schools.

The sessions were co-sponsored by the American Medical Student Association, a long-standing supporter of a single-payer system that has about 30,000 members nationwide.

It was clear from our local meetings that growing numbers of our medical students reject our dysfunctional, insurance-based system. They want something better. Many understand there is a breathtakingly simple solution: fix the limitations in Medicare and provide it to every American. More than 30 percent of the health care dollar today is wasted on the administrative costs associated with the private health insurance industry; Medicare spent only 1.5 percent on administrative costs during 2011.

A landmark study in the New England Journal of Medicine (2003) showed that by replacing our fragmented, inefficient patchwork of multiple insurers with a single, streamlined, nonprofit agency like Medicare that pays all medical bills, our nation would save about $400 billion annually in reduced administrative costs � enough money to provide comprehensive, high-quality coverage to every American for no more than our nation spends now.

According to Gerald Friedman, professor of economics at the University of Massachusetts-Amherst in the March/April 2012 issue of Dollars and Sense, “a single-payer system would save as much as $570 billion now wasted on administrative overhead and monopoly profits.” Spending would increase by $326 billion from expanding coverage and adjusting Medicaid rates. Americans would net a savings of $244 billion, enjoy universal coverage and eliminate the dreadful scenarios described above. Disposable income would increase for 95 percent of Americans.

Because a single-payer system would possess enormous bargaining clout, it also would be able to rein in costs for pharmaceutical drugs and other medical supplies over the long haul.

I believe that adopting an “improved and expanded Medicare for all” is the best way for students and physicians to return to their mission of caring for our patients, rather than squandering our time navigating administrative barriers erected by insurance companies. And make no mistake � these are barriers to care, with dire consequences.

Although we spend more on health care per capita than any other country in the world, American life expectancy ranks 38th.

My colleagues and I came away from our student meetings confident that the future of medicine is in good hands. The medical students we met didn’t get lost in jaded political quagmires.

They know it’s inevitable. They just want it to happen now.

Me too.

Dr. Ed Weisbart is chairman of Physicians for a National Health Program�St. Louis.

The Lion Sleeps Tonight

Spoiler alert: this is not a fawning, gushing, lie-filled eulogy of Saint Edward Kennedy. Read no further if you believe the �Liberal Lion� or as I prefer to call him, the �Lion King,� actually made this country a healthier, more equitable place to live in. You have been warned�.

*Conflict of interest, almost full disclosure: I grew up in Massachusetts and spent several weeks each summer in Buzzards Bay, Cape Cod at my aunt�s house. There were yearly treks to Hyannis Port to pay respects to slain President John F. Kennedy and to gaze forlornly at his eternal flame. We gaped slack jawed though, at the massive, sprawling and luxurious �Kennedy compound� with stunning ocean views. I was taught to believe the Kennedy clan was royalty, a little piece of Camelot in the Yankee Bay State. Portraits of Kennedy family members were embossed on everything from mugs to rugs.

This is the anti-eulogy, the antidote to the reams of press coverage proclaiming Kennedy – the spawn and scion of one of America�s most wealthy and powerful families � to be the most effective, spectacular lawmaker in the history of the Senate, a man who worked on behalf of the poor and downtrodden. This latter characterization of Kennedy makes me crazy. He cared about the poor and oppressed when it was politically expedient and when pushed by events happening around him. And it was always about him, about advancing his career and individual and family notoriety for supposedly doing good deeds, of getting yet another piece of legislation or building named �Kennedy.� In fact, Saint Edward knew very little of the lives of the oppressed and disenfranchised in America. He shuttled decade after decade between the secluded and secured, exclusive enclave of the Kennedy Compound in Massachusetts and the inner sanctums of the �Millionaires Club,� er, the United States Senate in Washington, DC. According to the Center for Responsive Politics, Teddy was the seventh richest member of Congress weighing in at over $100,000 million.

Kennedy never worked to get anything: his career in politics was handed to him the old fashioned way, via family connections. Nepotism. Moreover, name recognition and the family fortune bought him a lifetime seat in the Senate that the Kennedy clan always believed was their personal property and birthright.

Much was made of the Lion King�s �unbridled appetites,� in particular for women and booze. That rich and powerful playboy men have numerous wives, girlfriends, mistresses, liaisons, and messy affairs is not surprising. Membership in the good ole� boys club of rich and powerful men bestows that right. That Kennedy drank heavily for most of his life is not surprising, either. Think about it: when you are caught cheating at Harvard and are humiliated and expelled; when you�re dodging the draft and at a loss as to what to do with your pampered and privileged life and daddy gets you a cushy, do-nothing NATO job in Paris for a couple of years; when you feel inferior to your older, smarter brothers (one, of course, made it all the way to the highest office in the land) and then both are murdered, shot in cold blood; when one night you drive your car off a bridge into the sea and are responsible for your passenger drowning to death and you head home and go to sleep and the next day your first instinct is to call your closest political advisors; when a sister and nephew die in plane crashes; when you almost die in a plane crash, well, there are more than a few reasons to drink. Night after night, year after year Teddy had a lot of reasons to hit the bootleg scotch daddy trafficked in. I could almost forgive and forget Kennedy all those mistakes and tragedies because despite the silver spoon in his big Brahmin Boston brogue of a mouth, Teddy was curiously, stubbornly, human.

What I cannot ever forgive or ever forget is Kennedy�s record on health care. He called it �the cause of my life.� Even a cursory glance at the senator�s record shows he was a colossal failure at the cause of his life. How is it that the American mainstream media and even some left-wing media get away with promoting Kennedy as successful reformer of health care when the country is facing a health care crisis of staggering proportions? Two statistics speak volumes: 50 million uninsured and at least 20,000 people die every year due to lack of access to health care. If Kennedy was so committed to the plight of the uninsured and making health care accessible to everyone in the 46 years he was in the senate, why the hell is the health care crisis killing so many, swelling the ranks of the uninsured every day, and threatening to crash the economy? Here�s why: decades ago Kennedy sold out to the blood sucking, profit-hungry, killer insurance corporations.

It�s hard to believe looking back now, but the Lion King started out with the right idea. In1971, Kennedy, along with Representative Martha Griffiths (D-Mich.), supported the Health Security Act. It eliminated the role of the commercial insurers entirely and created a single-payer, government financed health care system. The Kennedy-Griffiths bill, as it came to be called, was a watershed in American politics and would have, if passed, made health care a human right and divorced health care from employment status for good. He had solid backing from the labor movement. Kennedy faced off against evil President Richard Nixon�s health care plan and charged that it �would provide the insurance industry with a windfall of billions of dollars annually.� Teddy was right.

Then between 1971 and 1974, Kennedy gave up, he completely abandoned single-payer, national health care and became the great compromiser. His next piece of health care legislation was the Mills-Kennedy Bill. It was the opposite of Kennedy-Griffiths. It maintained the link between employment and insurance, didn�t include the entire population and required those with coverage to shoulder much of the expense of basic medical care through high deductibles and co-pays. Labor refused to endorse the Mills-Kennedy bill and in a meeting with members of the Committee for National Health Insurance, Kennedy reportedly was furious and belligerent and said he resented the charge made against him that he was �selling out on the health issue.� Consumer advocate Ralph Nader and his organization Public Citizen Research Group also criticized Kennedy for selling out and caving to the insurance industry. But that�s exactly what Kennedy did and he never fought for single-payer health care again.

In 1979, Kennedy submitted to Congress the mistitled Health Care for All Americans Act, which became known as the Kennedy-Waxman bill. It was another rotten compromise that didn�t uproot the fundamental problems at the core of the health care system. It required employers to pay up to 65 percent of employee health insurance premiums. The legislation went nowhere and the number of uninsured increased.

Fast forward to 1993. Kennedy was an ardent supporter of the Clinton health care reform overhaul. Hillary Clinton organized a Health Care Task Force of powerful members of the insurance and pharmaceutical industries. The health care reform proposal from members of Physicians for a National Health Program (PNHP) was arrogantly dismissed. The meetings were conducted in secrecy and the Association of American Physicians and Surgeons, along with several other groups, filed a lawsuit against Clinton over the closed-door meetings. The bill that finally emerged was 1000 pages long, the complexity – stunning. It was a disaster: an enforced mandate for employers to provide health insurance to workers through health maintenance organizations (HMO�s.) It never passed, but the terrible era of HMO hegemony began.

The Kennedy-Kassebaum bill (1996) was another incremental attempt to stop the hemorrhaging in the employment-based system of health care provision. It was DOA – dead on arrival. Named the Health Insurance Portability and Accountability Act (HIPAA), it was intended to narrow conditions under which insurers could refuse coverage. What finally passed was a watered-down bill that eliminated a few of the more egregious practices of the small group market. However, HIPAA didn�t stipulate that health insurance policies had to be offered at an affordable rate and it contained enough loopholes to allow insurers to avoid covering people with chronic and �expensive� health conditions. At the time of its passage, the American Academy of Family Physicians (AAFP) released a statement saying, �Although this doesn�t solve the nation�s problems with lack of insurance and under-insurance, this legislation does increase the security blanket for many who can already afford health coverage. Now, Congress and the president must turn their attention to extending affordable health insurance to the more than 40 million Americans who have no health coverage.� Gee Teddy, thanks for your life-long commitment to make quality health care a reality for all Americans.

The year 2006 was a double debacle and setback for fundamental health care reform. Kennedy heartily supported the draconian Massachusetts mandate that funneled millions of government subsidized dollars into insurance industry coffers and punished people that didn�t buy their defective product by stealing their tax refund. Three years later the Massachusetts mandate is unraveling as we knew it would. It never included undocumented immigrants, benefits for legal immigrants are being drastically cut, and over 200,000 people are still uninsured. Kennedy�s second miscast vote was in favor of the now widely acknowledged pharmaceutical industry give away, commonly known as Medicare Part D. Besides being inordinately complex, the legislation forbids the federal government from negotiating drug prices. Kennedy sided with the drug company vampires in bamboozling and ripping off millions of seniors.
With Obama�s election, Senator Kennedy, by now the all-time health care legislation loser, again went to work on health care reform, but this time with an incurable brain tumor growing in his head. President Obama promised transparency and all views would be heard in the health care debate. Saint Edward, accountable to no one, held secret, closed door meetings with the same cast of crooked corporate characters responsible for the health care crisis. Perched at �Ted�s table� were lobbyists from America�s Health Insurance Plans (AHIP), big PhRMA, and the Business Roundtable. Single-payer activists didn�t find out about the clandestine meetings until the New York Times ran a front page article exposing them and were rightfully outraged at being shut out once again. Kennedy�s proposal to reform health care this last time around: the Massachusetts Mandate grafted onto the entire country.

The more things changed, the more Kennedy stayed the same. He never heeded his oft quoted, unoriginal and hokey one liner, �Sometimes a party must sail against the wind.� He sailed with the entrenched, profit-gouging, corporate, hurricane force winds that control health care, inflict, and are responsible for unspeakable suffering and death. Kennedy bears responsibility, too, and has the blood of hundreds of thousands of people on his hands. Because it could have turned out very differently. If Kennedy hadn�t given up the fight for the National Health Act in 1971 the United States wouldn�t be mired in a massive health care meltdown today. Kennedy was especially well positioned to take on the powerful insurance industry and pass legislation that evicted them from health care and created a government financed health program. He was independently wealthy and didn�t need corporate campaign donations to fund his reelection campaigns. He had the power and prestige of the Kennedy name, the connections and tons of money to keep up the fight for as long as it took. Remember, he served in the senate for 46 years! If the liberal lion had shown any courage or had any balls (lions have big balls, but perhaps not if they�re liberals) and actually stuck to the uncompromising principle that health care is a human right for all, not a commodity, he could have claimed a well deserved and genuine legacy as a champion of health care reform, he could have gone down in history as the Aneurin Bevan of American health care. But he didn�t, so he can�t.

An astute politician summed up Kennedy�s career this way: �Usually at the end of the day, he [Kennedy] would make a compromise that his most loyal fans would be disappointed with. �Oh, you�ve given up too much, Teddy� � but he would know how much you needed to give up to pass the bill��

Helen Redmond, LCSW, CADC, is a member of Chicago Single-Payer Action Network (CSPAN.) She blogs at http://helenredmond.wordpress.com and can be reached at redmondmadrid@yahoo.com

This article was written in memory of Marilyn Clement and Nick Skala. Marilyn was the national coordinator for Health Care Now! and Nick was a senior research associate at Physicians for a National Health Program (PNHP.) Both were fierce advocates for single-payer and never sold out.

Obama, Romney On Health Care: So Close, Yet So Far

From now until November, President Obama and GOP presidential candidate Mitt Romney will emphasize their differences. But the two men's lives actually coincide in a striking number of ways. In this installment of NPR's "Parallel Lives" series, a look at one of those similarities: They both signed health care overhaul laws based on an individual mandate.

Health care has become one of the starkest contrasts between President Obama and Republican rival Mitt Romney in the 2012 campaign. And that's surprising, given that once upon a time they both came up with similar plans to fix the system.

Stuart Altman, a professor of health policy at Brandeis University, says the two men once occupied the same political space on health care.

"I would define Obama as a moderate liberal and Romney as a moderate conservative. ... Both of them came to the same conclusion," he says. They decided what was needed was a system "built as much as possible on the existing health insurance system."

Both men embraced what was considered to be mainstream health care policy thinking: maintain the employer-provided system but get everyone covered through an individual mandate � a requirement to buy insurance.

From Victory To Problem

Romney went first. In 2006, as Massachusetts' governor, he talked about the state's mandate in decidedly nonideological terms: "We're going to say, folks, if you can afford health care, then gosh, you'd better go get it; otherwise, you're just passing on your expenses to someone else. That's not Republican; that's not Democratic; that's not libertarian; that's just wrong."

Getting rid of free riders was a moral issue for Romney and many Republicans back then, says Jonathan Gruber, an MIT economist who helped the Romney and Obama administrations design the individual mandate. Gruber says he could tell that health care overhaul had a particular appeal for Romney � a businessman who specialized in turning around troubled companies.

"Mitt Romney was a management consultant. And what management consultants are is they're sort of like engineers. They go in, they see a problem, they solve it," he says. "I saw a lot of excitement, this passion, to say, 'Wow, we can move this piece around, add the mandate, rededicate the money, put it together and we can solve this important problem. Isn't that really neat?' "

Just as passing a national health care law was supposed to be the legacy achievement for Obama, Gruber says that back in 2006, as Romney got ready to run for president, the Massachusetts law also looked like a surefire political winner.

"You can understand his thinking, right? He thought, 'Look, I can run for president by saying I solved this intractable problem by bringing conservative principles to bear � individual responsibility, the health insurance exchange.' I mean, there was a guy from the freaking Heritage Institute on the stage with Romney at the bill-signing," Gruber says. "This was a victory for Republican ideals, a victory for using market forces to solve an intractable problem, and I think that Romney probably thought, 'Isn't this a great thing I can run on as a Republican?' ... I would have thought so, too."

Changing Positions

Over time, Obama and Romney have had a mirror-image relationship with the linchpin of their health care laws: Romney was for the mandate before he was against it. Obama was against the mandate before he was for it.

"The irony is even worse than that," says Altman, the Brandeis professor. "I worked for Obama during the election and he was adamantly opposed to the individual mandate. ... I was on his advisory group, and we said, 'But you know, you really do need an individual mandate to make this all work together.' He said, 'I won't support that because you're asking, you know, not wealthy people to buy expensive insurance. We've got to get the cost down.' "

During the 2008 Democratic primary, the mandate was the single biggest policy divide between Obama and opponent Hillary Clinton.

In a debate, candidate Obama blasted Clinton's plan for an individual mandate by citing the experience in Massachusetts.

"Now, Massachusetts has a mandate right now," he said. "They have exempted 20 percent of the uninsured � because they've concluded that that 20 percent can't afford it. In some cases, there are people who are paying fines and still can't afford it, so now they're worse off than they were. They don't have health insurance and they're paying a fine."

A Shifting Middle

And Romney and Obama have something else in common, Altman says. They were both victims of the same political sea change: The Republican Party got a lot more conservative.

"Obama campaigned that he was going to be a different kind of a president. He was going to get things done; he was going to compromise," Altman says. "And when he got to Washington, he realized that the Washington that he thought was there wasn't there anymore. So the movement of the Republicans to the right ... hurt Obama and really put Romney in a bind."

Romney's bind was apparent in the GOP primaries, when conservatives questioned his ability to attack the president on a plan so similar to his own. But now, with the nomination virtually in hand, Romney is making health care the heart of his argument against the president.

"The president's plan assumes an endless expansion of government, with rising costs and, of course, with the spread of Obamacare," Romney says. "I will halt the expansion of government, and I will repeal Obamacare."

What was once a common bond is now a deep divide.

"I will not go back to the days when insurance companies had unchecked power to cancel your policy, or deny you coverage, or charge women differently from men," Obama says. "We're not going back there. We're going forward."

There is no overlap at all in the two men's current approaches to health care. If Romney is elected, he'll work to get rid of the law that was based on his own plan. If the president wins a second term, he will fight to keep what he can.

Xerox to build health insurance marketplace in Florida

DALLAS – Florida Health Choices, a corporation established by the state to improve access to care, has selected Xerox to administer its insurance marketplace.

According to Xerox officials, the program is designed to give small business and eligible individuals more flexibility in finding affordable health insurance and other services. The nine-year contract is valued at $68 million.

With partner CHOICE Administrators Exchange Solutions, Xerox will provide a cloud-based Web portal and online plan selection tool to give consumers and employers more information when making health insurance selections. The solution preserves the benefits of employer-sponsored insurance and eases the administrative burden for small businesses, officials said.

“We’re designing and supporting programs that increase access to health coverage for consumers,” said Will Saunders, group president, Government Healthcare Solutions, Xerox. “The solution we create in Florida will serve citizens and small business owners and help position the state as a leader in establishing a competitive and voluntary health insurance marketplace for small employers.”

Xerox will also provide eligibility determination and enrollment management services for the program, and operate a customer contact center to share information on marketplace offerings. These services will help Florida Health Choices handle the massive amounts of information involved with the marketplace quickly, efficiently and securely.

“We need a partner who can get a fully functional marketplace setup that is designed to serve Floridians now and into the future – delivering on both our short and long-term goals,” said Aaron Bean, chairman, board of directors, Florida Health Choices. “We’re confident Xerox will support us in establishing our marketplace quickly, while helping us to increase healthcare access to small business employees – one of our key priorities.”

Vendor Notebook: AeroScout and Futura Mobility partner for RTLS

Futura Mobility has partnered with AeroScout to provide real-time location system (RTLS) technology to hospitals. With the partnership, officials say Futura Mobility will leverage AeroScout’s real-time asset management solutions that deliver location and status of mobile assets and equipment. Key components of the collaboration include temperature and humidity monitoring, patient flow and safety.

Allscripts announced that Summit Medical Group, the largest physician-owned multi-specialty practice in New Jersey, has signed a long-term contract for managed IT services. With Allscripts Managed Services, Summit will focus on its core mission of providing world class patient care while using IT to improve clinical, financial and operational outcomes, officials say.

HID Global announced the production release of its next generation EDGE EVO and VertX EVO controller platform that brings intelligence and decision-making to the door for advanced and highly customizable networked access control solutions. EDGE EVO and VertX EVO offer an open and scalable development platform for the deployment of a wide range of access control functionality, including remote management options, real-time monitoring, report generation and more.

triCerat unveiled the beta version of its Scanect software, a remote scanning technology for healthcare settings that speeds scanning without sacrificing quality or security.
 
SRS announced that Pittsburgh Bone & Joint Surgeons has selected the SRS EHR and PM to replace the system it originally purchased for its seven physicians. PBJS provides high-quality orthopaedic care to the Greater Pittsburgh area of Pennsylvania.

Allscripts announced that Evangelical Community Hospital, in Lewisburg, Pa., has selected its Sunrise EHR system. The hospital already uses Allscripts solutions for its outpatient electronic health record. The addition of the Allscripts Sunrise Clinical Manager solution will help the Hospital migrate its inpatient data and information to an electronic format and provide a seamless and integrated electronic information solution across the hospital, officials say.

Press Ganey Associates and the American Medical Group Association announced the launch of a survey designed to help accountable care organizations (ACOs) and high-performing health systems identify opportunities for improving both efficiency and quality. The AMGA-Press Ganey Coordinated Care Solution, assesses a patient’s entire episode of care and enables better management of population health to create positive patient outcomes and maximize shared savings.

Get Real Consulting announced the launch of the AARP Health Record. The application architected and developed by Get Real, is a secure web based solution designed to empower people over age 50 to manage and improve their own health. This application allows users to enter, store and edit their personal health information in a central location and to selectively share it with caregivers, family members, doctors and other healthcare providers.

InterSystems announced that it has entered into an agreement with Missouri Health Connection for InterSystems HealthShare to be the technology foundation for Missouri Health Connection’s (MHC) statewide health information network. MHC is the state-designated entity chartered to oversee development of Missouri’s statewide health information network.
 
Availity announced the launch of its suite of expanded clinical documentation capabilities, and that four major health plans, seven vendor partners, and multiple physician groups and hospitals are live and successfully utilizing these solutions across its network. The solution suite automates the costly, manual exchange of clinical information needed to support the revenue cycle, as well as emerging value-based payment models and quality improvement programs.

Outcomes Health Information Solutions announced the launch of MA365, a solution that actively drives quality results for Medicare Advantage plans year-round. Launched from a single data platform, MA365 is an integrated suite of solutions that identifies and resolves disparities in care for Medicare Advantage members with the goal of getting needed care for members while also impacting a Medicare Advantage health plan’s Star quality ratings.

MedeAnalytics announced the launch of its Employer Reporting Resource Center. As healthcare expenses have outpaced inflation and revenue growth, companies have struggled to understand the value of their relationships with full-service health plans. Created in response to growing interest by health plans looking to better serve their group and administrative services only (ASO) customers, this resource center has been created to serve as an educational service to the healthcare industry.

Pegasystems announced its next-generation product development and management solution that enables health plans to better meet industry and customer needs by reducing time to market for new insurance and wellness products amid growing healthcare complexity. Pega Product Composer System provides a customer-centric approach to developing and managing innovative healthcare products, supporting product design, approval, operational readiness and implementation.

Would single-payer healthcare be less vulnerable to the court than the ACA?

If the Supreme Court does decide to strike down any or all of the Affordable Health Care Act, the implications will range from the political to the medical to the economic.

For me, such a decision will take its place among the more supremely ironic of unintended consequences: a law designed to avoid greater government intrusion into health care will have been invalidated as an unconstitutional overreach of government power, while a far more intrusive approach would have clearly passed muster.

How could this be possible? Welcome to the wonderful world of constitutional interpretation.

Let�s begin by imagining that Congress and the president decided to adopt a genuinely radical health care plan�the kind in place in most of the industrialized world. They decide on a �single-payer� system, where the government raises revenue with taxes, and pays the doctor, hospital and lab bills for just about everyone.

Put aside the question of whether this is a good idea, or an economically sustainable notion. The question is: would such a law be constitutional?

The answer, unquestionably, is �yes.� In fact, it would be the simplest law in the world to enact. All the Congress would need to do is to take the Medicare law and strike out the words �over 65.� Why is it constitutional? For the same reason Medicare and Social Security are: the taxing power. Its reach is immense. During World War II, the maximum income tax rate was 91 per cent (it was paid by few, thanks to loopholes, but still). The same Congress that could abolish the estate tax could set just about whatever limit it chose; it could impose a 100 percent tax on estates over, say, $5 million. If it decided that a national sales tax was an answer to huge budget deficits, it could impose one at whatever level it chose.

(The remedy, of course, lies with the voters, who would be more than likely to send a powerful message at the next election, which is why the lack of constitutional limits on the taxing power do not lead to confiscatory rates.)

So why is Obama�s health care plan, with a far more modest use of government power, in serious jeopardy? It�s because the key element in the plan�the �mandate� to purchase health insurance or pay a penalty�was not based on the taxing power, but on Congress�s power, under Article I, Section 8, to regulate interstate commerce. And that power, while broad, has its limits…even if those limits are murky.

Up until the late 1930s, those limits were more like shackles. The Supreme Court repeatedly struck down sate and federal laws regulating wages, hours and working conditions on the grounds that the commerce power only touched the distribution of goods, not their manufacture. But once the court changed its mind�after an effort by FDR to �pack� the court with additional justices had failed�there seemed to be no limits at all. Back in 1942, the court said the government could stop a farmer from growing his own wheat for his own use, because of the potential effects on the wider market. But in 1995, for the first time in decades, the court said �no� to a federal law based on the Commerce clause�one banning firearms within school zones�because it could find no reasonable connection between the law and interstate commerce.

In the health care case, the questioning by several justices indicated strong skepticism about the mandate. If the commerce clause can compel a citizen to buy a specific product�in this case, health insurance�what couldn�t it do? Could it, as the now famous question had it, compel citizens to buy broccoli on health grounds? (Well, a defender might have pointed out, the government does compel taxpayers to �pay for� all kinds of things in the form of government subsidies, such as ethanol. It could clearly do the same with a broccoli subsidy.)

As a policy matter, it�s clear that a �mandate� is a much more modest extension of government power than a single-payer system. The citizen would choose which insurance to buy; in fact, under the law, a citizen could choose not to buy any insurance, and pay a penalty instead. The whole premise of a mandate is to spread risk as widely as possible; as Mitt Romney used to note when he was defending the Massachusetts plan he designed, the mandate to prevent �free riders� from benefitting from treatment once they are sick or injured. That�s why the genesis of the idea came from such conservative roots as the Heritage Foundation.

As a constitutional matter, however, the idea of compelling a citizen into a specific economic activity raises alarm bells. It evokes the specter of some bureaucrat inviting himself into your home, while checking the shelves to make sure you�ve purchased multigrain cereal and cage-free eggs. (It�s a specter the administration tried to avoid by arguing that the health-care market is unique, one in which we are all likely participants at some point, voluntarily or otherwise. Unlike life in a Robert Heinlien libertarian �utopia,� hospital ERs do not have the power to say to an uninsured heart attack or auto accident victim: “you chose not to buy insurance? Sorry…have a nice day.�)

So, for its effort to design a health care plan that moved in the direction of less government intrusion, the Obama administration faces the distinct prospect of having its signature domestic program shot down for exceeding the limits of the constitutional power it did choose to use.

I somehow doubt the White House will appreciate the irony.

Romney's Health Care Prescription Gives Some Conservatives Heartburn

Enlarge Charles Dharapak/AP

Mitt Romney (right), at the time the governor of Massachusetts, greets then-Health and Human Services Secretary Mike Leavitt during a National Governors Association forum in February 2006. Romney reportedly has tapped Leavitt to head his presidential transition team.

Charles Dharapak/AP

Mitt Romney (right), at the time the governor of Massachusetts, greets then-Health and Human Services Secretary Mike Leavitt during a National Governors Association forum in February 2006. Romney reportedly has tapped Leavitt to head his presidential transition team.

GOP presidential candidate Mitt Romney insists that when it comes to health care, his first priority is the full repeal of the 2010 Affordable Care Act.

But some of his actions of the past few days have conservatives scratching their heads.

First, there was the appointment of Mike Leavitt, a former Utah governor and Health and Human Services secretary, to lead a potential Romney transition team.

Since leaving office at the end of George W. Bush's term, Leavitt has been running a group that has, among other things, been working to help states implement key portions of the law Romney has vowed to eliminate.

 

Needless to say, that didn't go over well among those who worry that Romney might not really be serious about obliterating the federal health law, which bears a striking resemblance to the one he signed as governor of Massachusetts. (More on that in a moment.)

"The fact that Romney picked Leavitt suggests he really doesn't mind Obamacare that much, and that he is just saying whatever he needs to say to get what he wants," blogged Michael Cannon of the libertarian Cato Institute. Cannon, by the way, has produced this video, which directly challenges Leavitt's business model by arguing why states should notestablish health exchanges.

Which brings us back to Romney and his Massachusetts plan. The Wall Street Journal has unearthed some old emails the Romney folks didn't manage to destroy suggesting that the former governor and some of his closest aides were even more in favor of the "individual mandate" than was formerly known.

But it's not just old emails where Romney's penchant to defend the mandate sneaks out. Here's how he described the Massachusetts law during a January GOP debate in Jacksonville:

"If you don't want to buy insurance, then you have to help pay for the cost of the state picking up your bill, because under federal law if someone doesn't have insurance, then we have to care for them in the hospitals, give them free care. So we said, no more, no more free riders. We are insisting on personal responsibility."

Of course he ended his thought by vowing, once again, to repeal the federal law, because he said, unlike the Massachusetts version, it "takes over health care for the American people."

Does the Health Insurance Industry Have Congress In Its Pocket?

No one ever talks about dismantling the Fire Department, Police Department, or Postal Service because they’re models of a scary socialist project. Why should healthcare be any different? Quite simply, the health insurance industry stands in the way. And as the Real News Network reports, they’ve been lobbying hard to make sure that a for profit system of care remains the law of the land. But labor, single payer advocates, and Americans who want basic healthcare are pushing back.

“We believe the health insurance industry is trying to buy their way onto the table with health care reform,” says Carmen Balber of Consumer Watchdog at a protest against the American Health Insurance Plans’ 2009 Policy Forum. “We see this in two big points,” she goes on to explain, “one which is a mandate that would require individuals to purchase private health insurance… and secondly we know the insurance industry is trying to block any sort of public option for the American people. They don’t want the competition, so we’re here to call out the insurance industry for trying to buy Congress’ position.”

You can see more videos at The Real News Network.

This article is from GRITtv.