Due to the volume of “hate” e-mail that I sometimes receive following one of my presentations, my attorneys have advised that I issue the following disclaimer. The following presentation is for mature audiences only. It may contain sarcasm, irony, and facetious metaphors that you may find offensive. There may even be data to suggest that the American health care system is not the greatest thing since sliced bread. These remarks should not be construed as insults aimed at President Bush, the Government of Canada, the people of France, or pharmaceutical industry techies. Viewer discretion is advised. Jeanne Scott talking-head-in-chief health-politics.com The Presidential Election 2008 and the Politics of U.S. Health Information Technology: What’s in it for You and Me? Scenario Consider this scenario: A family -- mother, father, two children -- who live in Grand Rapids, Michigan are visiting grandparents retired in Tucson, Arizona. Their oldest child, a six-year old boy, has a severe asthma attack. In a panic, an ambulance is called and the boy rushed to the nearest hospital. Scenario At the emergency room the boy’s mother hands the receptionist the family’s health identification card. A POS reader scans the card; the family's health care benefit plan and eligibility requirements come up on a monitor. • Is this a Smart Card? • Identifier Issues • Research Database Issues • Practical Needs/Practical Problems Scenario . . . A nurse quickly queries the system for the boy's current brief medical record synopsis. . . . The attending physician notes the boy's history of asthma, the medications he takes, and the pertinent results of his most recent health care encounter. •Needed: Development of a Computer-Based Patient Record •Needed: Master Patient Index •Issue: Privacy and Confidentiality Scenario After . . . administering emergency care, the physician inputs a summary of her findings, and a prescription for medication. The physician then closes and transmits the current transaction. . . . The family picks up the boy's medication at a local pharmacy on their way home to grandmother's house. •Needed: Industry Agreement on a Computer-Based Patient Record •Already On-Line: Pharmacy Management Program Scenario . . . the health care EDI system transmits the boy's new clinical data to his family’s health plan back in Michigan, which updates his personal medical record. •Needed: Development of a Computer-Based Patient Record •Needed: Master Patient Index •Issue: Privacy and Confidentiality Scenario Funds to pay for the hospital and physician's services are transferred from the family's plan to the health plans in Arizona to which the physician and hospital belong . . . . Any out-of- pocket payment owed by the family is calculated, and debited to the family's bank credit card account and credited to the appropriate accounts. . . . • Question: What will be the discount? Scenario The clinical and administrative records of the encounter are distributed to the physician's specific monitoring data base . . . and to the hospital’s management . . . where, . . . it may be accessed by the hospital's . . . manager's for evaluation and use in management decision-making. •Needed: Case-Mix and Practice Management Tools to Assess Quality and Economy •Needed: Self-Reporting/Analysis Tools to Build HEDIS and Other Report Carding Scenario Stripped of personal identifiers, . . . the boy's records are sent to a regional pharmacy database. His updated clinical record is similarly aggregated with other clinical data and stored in research files and in regional data bases where it may be accessed by researchers and others for evaluation of the treatments rendered, outcomes and effectiveness for future decision-making. •Challenge: Privacy, Confidentiality •Challenge: Cookbook Health Care Scenario At the family’s health plan . . . the data is compiled and added to the plan’s risk management database. In Texas, the physician’s plan records are updated and her performance is measured against the plan’s best practices protocols and childhood asthma disease management program. •Challenge: Building the Virtual Capabilities Scenario Information on the disease status, treatment, assessment, care and follow- up is compiled and sent to the local and state community public health agencies where it may be used in a variety of ways in developing community health standards and reporting. •Challenge: Building the Virtual Capabilities U.S. Health Care Facing the “Perfect Storm” • Healthcare Costs Rising at Annual Double Digit Rates • The Number of Uninsured Americans Rises, Despite Generally Low Unemployment, Reaching 46.8 Million in 2006 • Employers Increasingly Passing Costs of Health Insurance onto Employees Through Higher Deductibles and Co-Pays • Employers Increasingly Dropping Retirees and Others From Their Health Plans • The Collapse of the US “Employment-Based” Health Insurance System, Creating Categories of the “Working Poor” with No Coverage • Hospital Emergency Rooms with 12+ Hour Waits • 1965-2006: Drug Costs Go From Less than 4% of Total Healthcare Cost to Almost 14% • Medicare Part A Bankruptcy as Early as 2012 • Medicaid Bankrupting the States • And the list goes on and on … "I fear that we may have already committed more physical resources to the baby-boom generation in its retirement years than our economy has the capacity to deliver." "Congress in the future will have to weigh the benefits of continued access, on Alan Greenspan: November 25, 2005 current terms, to advances in medical technology against other fiscal initiatives." Social Security and Medicare, The Halftime Show The Bush Plan For Health Care • “Saving Medicare” -- President Bush has stated his support for raising age to70 and 72, “privatizing” Medicare – Ages 51>, Ages 36-50, Age 35< (President Bush, April 20, 2005) • Coverage for Prescription Drugs for America’s Seniors – Controlling the Future Cost of Part D, Now Predicted to Exceed $1.2 Trillion over its first 10 years – Seniors Feel Part D Falls Short of the Need. Can We Afford More? How? theJeanneScottletter President Bush Puts His Eggs in the Health Savings Account Basket Expand Health/Medical Savings Accounts: Allow Individuals and Families to Set Aside as Much as $5,150 a Year, Tax Free Bush’s FY2007 Budget would increase the allowable amount to $10,300 CDHC Will Only Work If … (a) Meaningful information is made available to the consumer… your buzzword for the year: TRANSPARENCY… for both prices and quality (b) The American population comes to ACCEPT it… but we’re dumber than bricks Internet Information is ALWAYS Helpful Transparency "No one knows what they pay for their health-care services. No one knows cost or quality. . . . We don't have any reason to care financially." -- Mike Leavitt Secretary of Health and Human Services TRANSPARENCY: ACCEPTANCE: The report by the Massachusetts Institute of Technology reviews data from the RAND Health Insurance Experiment to offer insights into current health policy debates about appropriate levels of cost sharing. The RAND experiment, conducted in the 1970s, randomly assigned families to health plans with different ranges of coinsurance and followed them for three to five years to determine how coinsurance levels affected their health and use of medical services. The Kaiser Family Foundation study found that higher coinsurance rates reduce use of health services and health care spending; that coinsurance plans did not have adverse consequences for individuals of average health and income when compared with a plan with no coinsurance; and that the health of high- risk people, especially those with low incomes, there were health benefits when they were enrolled in plans with no coinsurance. ACCEPTANCE: September 22, 1993 On September 22, 1993, Unnecessary & Ineffective Services, President Clinton went on Including Fraud & Abuse national television to explain the details of his health care reform proposal. In his speech, he referred to this pie chart. Of the $1 33% trillion in annual U.S. health care spending in 1993 -- less than 50% was actually 49% going to provide needed 18% care. We promptly rejected the President’s health care plan -- but these spending numbers are still with us in FY2007 when spending will be $2.2+ Administrative Overhead trillion. “We have a V.P of Medical records but we don’t know who it is because nobody can locate the file.” National Integrated Electronic Health Care Data Network Employers Consumers Comprehensive Quality States, Public Health Measurement Data Departments Secretary of DoD Health & Human Physicians Services Compliance, Certification, & Oversight Clinics Federal Health Care Programs Health Care Information Clearinghouses Uniform Indexing Hospitals Systems Interoperability With Other Networks Purchasing Home Health Cooperatives Community-Wide Health Health Care Information Agencies Management Information Value Added Networks Systems (CHMIS) Long Term Care Facilities Health Plans Center for Disease Control Rural Health Care “In the future Medicare will only pay for what works. It won’t pay for what doesn’t work” -- Dr. Mark McClellan (former) CM2 Administrator Running for Office One critical first step is to bring our 2008 health care system into the 21st century. Right now, technology exists that would allow primary care physicians to push a button and send prescriptions to your pharmacy. It is conceivable that emergency room attendants could access your medical files with handheld computers in the blink of an eye. And, the capability exists to have the latest research in the hands of your doctor in days – rather than years. All these things can be done while protecting patient privacy and in the process save time, money and lives. But the information technology infrastructure simply is not there. -- Sen. Hillary Rodham Clinton, (D-N.Y.) Running for Office The federal government needs a 2008 strategy to move as fast as possible to a 21st century intelligent health care system with the first step being an electronic health record for American. … Many healthcare providers worry about the lack of data standards for these technologies, particularly electronic health record systems. Today, if a facility or doctor invests in a sophisticated system, they are unable to electronically share patient data with others … they fear that their technology will be obsolete once there are data standards that connect all the silos. -- Newt Gingrich, former Speaker of the House http://www.healthtransformation.net/home/ Moving HIPAA to New Levels 1.Electronic Prescriptions 2.Systemic Interoperability 3.Electronic Health Record 4.Allocation of Resources The Future of Privacy FDA Approves Implantable Chip for Medical Records By Diedtra Henderson AP Science Writer Wednesday, October 13, 2004; 2:05 PM WASHINGTON (AP) -- The Food and Drug Administration on Wednesday approved an implantable computer chip that can pass a patient's medical details to doctors, speeding care. VeriChips, radio frequency microchips the size of a grain of rice, have already been used to identify wayward pets and livestock. And nearly 200 people working in Mexico's attorney general's office have been implanted with chips to access secure areas containing sensitive documents. Delray Beach, Fla.-based Applied Digital Solutions said it would give away $650 scanners to roughly 200 trauma centers around the nation to help speed its entry into the health care market. A company spokesman would not say how much implanting chips would cost for humans, even though chips have been implanted in some, including Scott R. Silverman, the company's chief executive officer. The company is targeting patients with diabetes, chronic cardiac conditions, Alzheimer's disease and those who undergo complex treatments like chemotherapy, said Dr. Richard Seelig, Applied Digital Solutions' vice president of medical applications. It's the first time the FDA has approved medical use of the device, though in Mexico, more than 1,000 scannable chips have been implanted in patients. The chip's serial number pulls up the patients' blood type and other medical information. With the pinch of a syringe, the microchip is inserted under the skin in a procedure that takes less than 20 minutes and leaves no stitches. Silently and invisibly, the dormant chip stores a code -- similar to the identifying UPC code on products sold in retail stores -- that releases patient-specific information when a scanner passes over the chip.At the doctor's office those codes stamped onto chips, once scanned, would reveal such information as a patient's allergies and prior treatments. The FDA in October 2002 said that the agency would regulate health care applications possible through VeriChip. Meanwhile, the chip has been used for a number of security-related tasks as well as for pure whimsy: Club hoppers in Barcelona, Spain, now use the microchip much like a smartcard to speed drink orders and payment. Electronic Prescriptions (HIPAA, Phase 2) Electronic standards have been developed and were published this past August in the Federal Register --- Physicians, hospitals and pharmacies choosing to transmit electronically are required to comply with the standards as of January 1, 2008 Warning: Other changes, and requirements in the pending malpractice and already passed medical error legislation virtually mandate e-prescribing theJeanneScottletter “Systemic Interoperability” (HIPAA, Phase 3) “Commission on Systemic Interoperability” (“CSI”) established by the MMA of 2003 (CBS sued over the acronym) CSI was supposed to establish a strategy to implement health information technology standards, including priorities and timeline for adoption nationally Reported to Secretary and to Congress in October 2005 its plan The final CSI report estimates it will cost $285B over 10 years to build this system theJeanneScottletter “Outcomes Research” and (gasp) Health Care “Rationing” MMA authorized Secretary to show: •“the appropriate use of best practice guidelines by providers and services by beneficiaries” •The “reduced scientific uncertainty” in the delivery of care through the examination of variations in the utilization and *allocation of services,and outcomes measurement and research” •achieving the “*efficient allocation of resources” •“the financial effects on the health care marketplace of altering the incentives for care delivery and changing the *allocation of resources” (* Trust me on this, I’m a lawyer, “allocation of resources” = “rationing”) theJeanneScottletter S. 1262: “Health Technology to Enhance Quality Act of 2005” “Health-TEQ” or… Frist-Clinton S. 1262, Health-TEQ: Frist-Clinton • Establishes (and most importantly funds) a formal “Office of National Health Information Technology” • Sets Goals for the Office, including: quality improvement; reduced errors; promoting “patient-centered medical care; reduced costs and paperwork; collecting accurate information on healthcare costs, quality, and outcomes; coordinating care among hospitals, laboratories, physician offices, and other entities; improve public health reporting (bio-terror attacks); facilitate new health research; and ensure privacy protection and security • Office Director is to facilitate the adoption of a national system for the electronic exchange of health information; • The bill would provide $500 million starting in fiscal year 2006 in annual $125 million increments in three-year 2-1 matching grants to help fund the development of regional or local health information technology plans, or RHITs, as well as such sums as necessary to fund the grant programs from FY 2007 through FY 2010. The funds also could be used to fund 10-year loans to develop RHITs. • The bill would require DHHS to certify that the networks complied with privacy, interoperability and other standards. RHITs would allow hospitals, doctors and nurses to quickly transfer patient information between facilities. • In addition, the legislation would provide $2.5 million annually from FY 2007 through FY 2010 to the Agency for Healthcare Research and Quality to help doctors' offices make sound IT investments. • Under the bill, Medicare payment "adjustments" would be available to physicians and suppliers who participate in the networks, but an amount is not specified. • Establishes a Stark “safe harbor” for hospitals to provide physicians with IT systems The “Final” Senate Version: S. 1418 • On November 18, 2005, the Senate by unanimous consent, passed the “Wired for Health Care Quality Act of 2005” (S. 1418). • The legislation would (among other things): – Establish legislatively the Office of the National Coordinator of Health Information Technology to coordinate with relevant federal agencies and private entities and oversee programs and activities to develop a nationwide interoperable health information technology infrastructure. – Require the Secretary to establish the public-private American Health Information Collaborative – Require the Collaborative to recommend to the Secretary uniform national policies to support the widespread adoption of health information technology, including: (1) protecting individually identifiable health information through privacy and security practices; (2) preventing unauthorized access to health information; (3) notifying patients if their individually identifiable health information is wrongfully disclosed; (4) facilitating secure patient access to health information; and (5) fostering the public understanding of health information technology. – Deem the standards adopted by the Consolidated Health Informatics Initiative as having been recommended by the Collaborative. – Require the Collaborative to annually review existing standards, identify deficiencies, omissions, duplication, and overlap, and recommend modifications and/or new standards. – Require the Secretaries of HHS, Veteran Affairs, and Defense to jointly review the Collaborative's recommendations. Require the Secretary of HHS to provide for the adoption by the federal government of any recommended standards, if appropriate. The “Final” Senate Version: S. 1418 • Prohibit any federal agency from expending federal funds to purchase any new health information technology that is inconsistent with adopted standards. Requires all federal agencies collecting health data to comply with the adopted standards within three years. • Require the Secretary to develop criteria to: (1) ensure uniform and consistent implementation of any standards voluntarily adopted by private entities; and (2) ensure and certify hardware, software, and support services compliance with applicable adopted standards. • Allow the Secretary to award grants to: (1) facilitate the purchase and enhance the utilization of qualified health information technology systems; (2) implement regional or local health information plans; and (3) carry out demonstration projects to develop academic curricula integrating qualified health information technology systems in the clinical education of health professionals. • Require the Secretary to develop measures of the quality of care patients receive and ensure that such measures: (1) are evidence based, reliable, and valid; (2) are consistent with the purposes of developing a nationwide interoperable health information technology infrastructure; (3) include measures of clinical processes and outcomes, patient experience, efficiency, and equity; and (4) include measures of overuse and underuse of health care items and services. The “Final” Senate Version: S. 1418 • Require the Secretary to: (1) adopt and utilize such quality measures; (2) implement procedures to accept the electronic submission of quality measurement data; and (3) disseminate recommendations and best practices derived from the analysis of quality measures. • (Sec. 3) Require the Secretary to carry out a study that examines the impact that variations among state laws relating to licensure, registration, and certification of medical professionals have on the secure electronic exchange of health information. • (Sec. 5) Require the Comptroller General to report on the necessity and workability of requiring health plans, health care clearinghouses, and health care providers who transmit health information in electronic form to notify patients if their individually identifiable health information is wrongfully disclosed. • (Sec. 6) Require the Secretary to study methods to create efficient reimbursement incentives for improving health care quality in federally qualified health centers, rural health clinics, and free clinics. • (Sec. 7) Require the Secretary, acting through the Director of the Agency for Healthcare Quality and Research (AHRQ), to develop a Health Information Technology Resource Center to provide technical assistance and develop best practices to support and accelerate efforts to adopt, implement, and effectively use interoperable health information technology. Requires the Secretary to establish a toll-free telephone number or Internet website to provide health care providers and patients with a single point of contact regarding health information technology. • (Sec. 8) Reauthorize appropriations for grants to reduce statutory and regulatory barriers to telemedicine. H.R. 4157 • On July 27, 2006, the House of Representatives approved the Health Information Technology Promotion Act of 2006 (HR 4157). The bill passed the by a vote of 270-148, with 138 Democrats opposing. On September 5, 2006, the bill was read for a second time and placed on Senate Legislative Calendar under General Orders. Calendar No. 587. • The legislation would (among other things): – Codify the Office of the National Coordinator for Health Information Technology within DHHS and would establish a committee to make recommendations on national standards for medical data storage and develop a permanent structure to govern national interoperability standards. – Establish (in legislation) the Office of the National Coordinator – Require reports from “American Health Information Community” – Require “Interoperability” planning – Provide grants to IHS to promote HIT to improve coordination of care for uninsured, underinsured, and medically underserved – Provide grants to small physician practices for HIT demos. – Require study and report on variation and commonality in state information laws and regulations – Establish safe harbors to anti-kickback civil and criminal penalties for provision of HIT and training services. – Promote Telehealth Services and EHRs – Study IHEs/RHIOs • That’s where it sits today… H.R. 4157, CBO Cost Estimates H.R. 4157, CBO Cost Estimates But Some Democrats Object • Essentially the Democratic objections boiled down to accusations that Republicans were not going far enough with this bill • Democrats said the bill was essentially toothless since it did not authorize funding and does not set a deadline for adoption of new technology standards • Some Democrats also blasted the bill for not including enough privacy safeguards such as patient consent for information sharing and requirements that patients be notified if their data security is breached Changing Billing Codes ? • The final House bill included a House Ways and Means Committee-supported provision that would increase the number of diagnosis and procedure billing codes that providers and insurers use from the current 24,000 codes to more than 200,000! But insurers say the October 2009 deadline for a transition to the new codes is too early to get adequate training. They would rather see such a move happen by 2012. What Will a Majority Democratic Congress Do? Well, according to Speaker-in-Waiting Nancy Pelosi: •Revamp Part D to Allow Government to “Negotiate” Prices with the Drug Companies •Currently, the Government Essentially Pays “Retail” Prices •Close the Part D “Donut Hole” •Address the Growing Number of Uninsured in America •Tax credits and incentives to employers to continue coverage •Review alternative coverage proposals: •Mandatory Individual Health Insurance with government subsidies (the “Massachusetts” plan) •Mandatory Employment Coverage (i.e., the “Maryland” plan) •During the Bush years, the number of uninsured has increased by over 5 million House Passes Drug Negotiation Bill House Democrats celebrating passage of the bill. Representatives Nick Lampson and Christopher S. Murphy are pictured on the left. Steven Kagen and Charlie Wilson share a laugh, right. The vote was 255 to 170, with 24 Republicans joining 231 Democrats in approving the legislation. •Expand S-CHIP, the Children’s Health Insurance Program •Enrollment has declined during Bush years •Re-open the Issue of Embryonic Stem Cell Research •“Investigate” the Health Care Industry: •Health Insurer Profits •Drug Company Anti-Competitive Activity •Blocking Generics, Predatory Pricing Practices •(PhRMA gave 15-1 PAC money to Republicans) •Non-Profit Hospital Collection and Charity Practices •Overpayments to Medicare Managed Care Providers and their “Favorable” Status Under Bush But remember, George W. Bush will still be President and the Dem “majority” is very, very slim! theJeanneScottletter HEALTH CARE REFORM UPDATE Update #385 November 13, 2006 Copyright: Jeanne Scott Matthews, 2006 HEADLINE NEWS (1) ELECTION 2006: THE WINNERS AND LOSERS *** WINNERS: Health Care I.T. Companies: Senate Health, Education, Labor and Pensions Committee ranking member Ted Kennedy (D), who is expected to become its chaircritter, likely will likely bring up legislation that would require health care providers to implement electronic health records systems and standardize EHRs to allow transmission between providers. theJeanneScottletter *** (4) H.R 4157: THE HEALTH CARE INFORMATION TECHNOLOGY LAW EVERYONE SAYS THEY WANT BUT NO ONE SEEMS ABLE TO PASS In the last weeks before adjourning to go home to campaign for last week’s elections, House and Senate negotiators couldn’t reach agreement on health care I.T. legislation. Congressional aides said the disagreements were based on language in the bill that would have allowed hospitals to donate I.T. to physicians' offices without fear of prosecution under a law that bars hospitals from increasing financial incentives to doctors who refer patients to their facilities. It is now unclear what will happen with the legislation when Congress returns in this coming week. The House bill (HR 4157), approved on July 27, would codify the Office of the National Coordinator for Health Information Technology within DHHS; establish a committee to make recommendations on national standards for medical data storage; and develop a permanent structure to govern national interoperability standards. The legislation also would clarify that current medical privacy laws apply to data stored or transmitted electronically and would require the DHHS secretary to recommend to Congress a privacy standard to reconcile differences in federal and state laws. Under the bill, the number of billing codes health care providers use to file insurance claims would increase from 24,000 to more than 200,000 by October 2010. In addition, the legislation includes an exemption of anti-kickback laws that would allow hospitals to provide health care I.T. hardware and software to individual physicians. The Senate bill (S 1418), approved in November 2005, does not include the provision on billing codes or the exemption of anti-kickback laws. Lawmakers have differences over the provision on billing codes and the exemption of anti-kickback laws, as well as funding, privacy protections and interoperability. Just Between You and Me: While many health care lobbyists are still saying that lawmakers will resolve differences over the legislation during next week’s lame-duck session, don’t hold your breath. Democrats are keen on making health care I.T. a “signature” issue for 2008. Ted Kennedy and Hillary Clinton have their own proposals to make … and to claim credit. theJeanneScottletter *** (5) U.S. DOCS ARE SLUG-A-BUGS WHEN IT COMES TO ELECTRONIC HEALTH RECORDS AND OTHER HEALTH I.T. APPLIVATIONS About 28% of U.S. primary care physicians (PCPs) use electronic health records, compared with 98% in the Netherlands, 92% in New Zealand, 89% in the United Kingdom, 79% in Australia and 42% in Germany, according to a study published last week on the Health Affairs Web site. For the study, sponsored by the Commonwealth Fund, researchers surveyed more than 6,000 PCPs in seven nations and found that only Canadian physicians, at 23%, used EHRs at a lower rate than U.S. physicians. The study also found that 23% of U.S. PCPs had computerized systems to inform them of potential problems with prescription drug interactions, the lowest rate among physicians in all nations except Canada. About 93% of Dutch PCPs had such systems, the study found. In addition, the study found that 15% of U.S. PCPs received computerized alerts to provide patients with test results, compared with 53% of U.K. physicians, and that 18% of U.S. PCPs used computer systems to send patients reminders for preventive or follow-up care, compared with 93% of New Zealand and 83% of U.K. physicians. According to the study, 20% of U.S. PCPs had the ability to produce lists of patients who are due or overdue for tests or preventive care, compared with 82% of New Zealand and 64% of German physicians. About 19% of U.S. PCPs had computerized systems to assist them with seven or more functions in clinical care, compared with 87% of New Zealand and 83% of U.K. physicians, the study found; theJeanneScottletter *** (5) U.S. DOCS ARE SLUG-A-BUGS WHEN IT COMES TO ELECTRONIC HEALTH RECORDS AND OTHER HEALTH I.T. APPLICATIONS *** The study also found that: • 30% of U.S. PCPs had financial incentives to improve the quality of care they provide, compared with 95% of U.K physicians; • 40% of U.S. PCPs had arrangements for after-hours care, compared with 95% of Dutch, 90% of New Zealand, 87% of U.K., 76% of German and 47% of Canadian physicians; • U.S. PCPs reported the highest rate of patients who had problems with out-of-pocket health care costs; • 33% of U.S. PCPs routinely provided patients with chronic diseases written instructions about care management, compared with 63% of German and 14% of Canadian physicians; and • 9% of U.S. physicians reported long wait times for diagnostic tests, compared with 57% of U.K. and 51% of Canadian physicians. • The study concluded that U.S. PCPs have "less capacity to ensure accessible, high-quality or patient-centered care" than physicians in other nations. "Cohesive, broad-based policy changes“ might improve the U.S. health care system, according to the study. Large Majorities Expect to Make Investments in Information Technology and New Construction in the Short-Term Planned hospital actions in the next 2 to 5 years Make a significant investment in IT systems 86% Initiate new building construction 85% Increase consumer advertising 70% Implement more aggressive collection practices 48% Modify fees for consumers paying OOP 44% Add surgical or operating facilities 43% Open satellite patient care facilities 40% Add hospital beds 38% Negotiate hospital rates with individual patients 37% Purchase physician group practices 24% The Argument for HIT • Potential for improving safety and quality • Long term costs saving – Shorter lengths of stay – Reduced duplication – Better DSM • Basis for transformation of clinical processes • Better compliance by patients, physicians, caregivers in practice standards • Interoperability across continuum So when your turned away from the ER at least they had your record HIT: Momentum is Building but…. • HIT is good thing don’t get me wrong • EMR is a PET • It won’t save money quickly • Expectations are too high, but …… – You gotta spend to save – You create a platform for improvement – We do not have another idea – Strong bi-partisan support conceptually ….. Show me the money • The power of simple disease registries: what can you achieve on 3x5 cards and a telephone • Will we really do the hard process redesign and culture work? • Interoperability is critical issue across the continuum of care, institutions and communities • What about the vast rabble of American doctors? • Who is going to do all this work? Physician Use Of HIT Is On The Rise SOURCE: Center For Studying Health System Change Data Bulletin #31 June 2006 Four Scenarios for US Health Care 2005-2015 Individual Government Bigger Tiers Я’Us Government Minor Delivery System by Request Reform 40% 30% “Reasonable” Disruptive National Innovation Healthcare Major Delivery System Reform 10% 20% Issues and Impacts • High end patients and providers will always do well • How bad will it be for the rest of us? • True cost reducing technologies will always have appeal • True clinical breakthroughs that are radically better than existing modalities and therapies will always be rewarded • Healthcare is a superior good and will take a larger share of national wealth • But who pays for what and how will be central difficult questions for business, government, and households around the world forever • Transforming for good: It’s all about Information and Incentives Issues and Impacts • No matter what, we will need better value measures and more transparency of measures • Value based purchasing and P4P will become more prevalent and have a powerful influence on providers and vendors • Consumers will become more engaged in value decisions but we cannot rely on them absolutely • The systems of healthcare need to be continuously improved to deliver greater value • Will require clinical skills, process skills, use of cutting edge technology and big-time capabilities • Most of all, it will require vision, values and leadership There’s Not Much We Have to Change…. Except……… • Our values • Our Strategic Focus: From Pimp my Ride to Primary Care and Prevention • Our Reimbursement System • Our Delivery System • Our Individual and Collective Behavior • Our Expectations Jeanne Scott (703) 371-4894 www.health-politics.com From Grandma Jeanne’s World’s Smartest Grandchildren • When my granddaughters Caitlin and Hannah were 7 and 5, respectively, I started telling them about what I used to do when I was their age. "We used to skate outside on a pond. I had a swing made from a tire; it hung from a tree in our front yard. We picked wild raspberries in the woods." Hannah, the littlest one, looked up and said to me: “Grandma, I sure wish I'd gotten to know you sooner!" • Elvis, my now 4-year old grandson once asked me, "Grandma, do you know how you and God are alike?" I mentally polished my halo, while I asked, "No, how are we alike?" "You're both old," he replied. • It was Elvis this year, who called me to wish me a Happy Birthday. He asked me how old I was, and I told him, "63." He was quiet for a moment, and then he asked, "Did you start at 1?" From Grandma Jeanne’s World’s Smartest Grandchildren • When Caitlin was just 4, she visited me at my office one day and was diligently pounding away on an old typewriter I keep to address envelopes and the like. She told me she was writing a story. "What's it about?" I asked. "I don't know," she replied. "I can't read." • I didn't know if my two and half year old twin granddaughters, Maggie and Iris knew their colors yet, so I decided to test them. I would point out something and ask what color it was. They would take turns answering me, and they were always correct. But it was fun for me, so I continued. At last Iris headed for the door, saying as she left, "Grandma, I think you should try to figure out some of these yourself!" From Grandma Jeanne’s World’s Smartest Grandchildren • Eamon, our five-year-old grandson couldn't wait to tell his grandpa about the movie he and I had watched on television, "20,000 Leagues under the Sea." The scenes with the submarine and the giant octopus had kept him wide-eyed. In the middle of the telling, my husband interrupted Eamon "What caused the submarine to sink?" With a look of incredulity Eamon replied, "Grandpa, it was the 20,000 leaks!!" • One hot summer night, my grandson Eamon and I were going in to our condo in NC, we kept the lights off until we were inside to keep from attracting pesky insects. Still, a few fireflies followed us in. Noticing them before I did, Eamon whispered, "It's no use, Grandma. The mosquitoes are coming after us with flashlights." • When Eamon asked me how old I was, I teasingly replied, "I'm not sure." "Look in your underwear, Grandma," he advised. "Mine says I'm four to six." From Grandma Jeanne’s World’s Smartest Grandchildren • When Hannah was in second grade, she called me on the phone and I asked her what she had learned in school that day. "Grandma, we learned how to make babies today." More than a little surprised, I tried to keep my cool. "That's interesting," I said, "How do you make babies?" "It's simple," replied the Hannah. "You just change 'y' to 'i' and add 'es'." • We took Elvis and his sisters Maggie and Iris to a demonstration at our local fire department. Sitting in the front seat of the fire truck was a Dalmatian dog. Several children nearby started discussing the dog's duties. They use him to keep crowds back," said one youngster. "No, said another, "he's just for good luck." Elvis brought the argument to a close. "They use the dogs, he said firmly, "to find the fire hydrant."
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