Reform Moves Forward

After some intense political horse trading a reform bill has moved forward in the Senate, with further voting possible before Christmas. Nebraska will be better off, should this pass.

Assuming the Senate passes a bill, the next procedure would be for the House and Senate to attempt to reconcile the bills. This is far from over.

Washington Marches On

The effort to shape a health care reform bill (that can pass) in the Senate continues.

Stay tuned. This process is ugly, but may be some will happen.

CER Hits a Snag

Comparative Effectiveness Research (CER) may have inadvertently lost credibility even before health care reform is actually launched.

CER is the darling of the government-dominated health reform movement (not a government take-over, to be clear). The use of evidence-based medicine when combined with cost-benefit analysis has the potential to save a great deal of money while better serving the patients. Many see downsides though; too rigid protocols and interference with physician judgment, or the dirty "R" word, rationing.

The U.S. Preventive Services Task Force recently released a study on various breast cancer screening modalities, recommending more limited screening protocols, particularly delaying routine mammography until age 50 (except in women with unusual risk factors).

Kah – boom!

USPSTF points out film mammography does cut mortality, with the greatest reductions in women over 50, with the best results in the age 60 – 69 cohort. Film mammography does carry a risk of false positives and the pain and inconvenience of unnecessary biopsies.

USPSTF also recommends ceasing mammography on women over 74, citing a lack of reliable evidence of reduced mortality.

There was a huge backlash from women, physicians, cancer activists and some health care associations.

USPSTF also recommends against teaching women to perform ”breast self-exam” (BSE) which has been a standard tool for decades. More backlash.

USPSTF does point out that digital and MRI mammography do not show, at this time, significant improvement over film mammography, but do have greater costs.

None of the conclusion appear to have been made on strong and startling statistics, but on think pros and cons, as one might expect from quants and scientists.

Women apparently want a little less quant and a lot more consideration.



USPSTF report:

http://www.annals.org/content/151/10/716.full

Game On!

The 1920 page House bill was passed and the 2020 page Senate bill is now subject to active debate.

Keeping up with the details is impossible, but we monitor the key points as best we can.

Game on!

HIPAA Security Alert

HIPAA Horrors

The Blade (Toledo) reports on October 28th an imaging technician was arrested in Ohio for driving infractions and possession of marijuana.

During the arrest the police scanned his cell phone.

In his phone were photos of dozens of partially clad patients preparing for imaging tests, including minors.

Wow.

The penalties and lawsuits are likely to be massive.

HIPAA Security Alert

Do you trade-in or donate used cell phones?

Before you do, you MUST scrub all of the data from the phone.

Game On!

The Senate Finance Committee is holding hearings today, likely focused on the "public option," with serious disagreement even among Democrats.

Senator Baucus has been in the lead in the Senate, but his opposition to the public plan (he thinks the plan, whatever the merits, would kill the bill) has irritated some senior members of his own party.

Stay tuned.

Reform Round 2

President Obama's speech yesterday was "hitting the reset button" for health care reform.

First impressions - the numbers do not add up.

And every President since Nixon has promised to reduce "waste, fraud and abuse" from Medicare and Medicaid.

Game on!

HIPAA Security Social Nightmares

Facebook ™, Myspace ™, Twitter ™ and millions of web logs (“blogs”) are connecting people worldwide, and that includes your employees.

Some business organizations are using these social networks, some not, but either way it is a good bet your employees are using these sites to connect with and expand their social networks.

That can be a huge problem!

Employees used to flashing every aspect of their lives on-line are very likely to discuss work on-line as well.

Social networks sites create a huge risk for HIPAA violations, and also for employee problems (some of the comments posted can be incredibly vicious),

HIPAA is 24/7!

No, you cannot control your employees lives, EXCEPT as it relates to work.

Every health care organization should develop policies and procedures on the use of social networking sites for the broadcast of work related information. Soon.

The Doomsday Scenario

So why are conservatives so excited about health care reform?

Many see the progressive left pushing a gradual move to the Doomsday Scenario, something like this:

1) private health insurance is hyper-regulated, underwriting standards are eliminated, and premium costs rise astronomically

2) employers, especially smaller employers, drop coverage and push employees to the “public plan”

3) the resulting dislocation of coverage and expansion of the public plan becomes a rationale for single payer – “see, we told you so.”


Having read thousands of pages of reform material over the past 18 months, and having studied the various reform movements since the early 90s, I think the Doomsday Scenario is quite feasible, and certainly I wouldn’t put it past the progressive left.

In public President Obama emphatically denies any such scenario. However, if the Scenario were to evolve, would he revert to his earlier ideas on single payer?

My request is for an honest debate. If Obama really wants to move to single payer, he should say so, and let the real debate begin.

For now, expect fireworks (not excusing rude behavior by the way).

Models for Reform?

President Obama often cites the Mayo Clinic and the Cleveland Clinic as models for providers in a new era of health care reform.

Question: Can these two models be replicated throughout the country?

Answer: Not likely. Certainly not in the near term.

The Mayo Clinic is unique but has replicated itself a few times, and the Cleveland Clinic is unique and to the best of our knowledge has not been replicated.

Even if these models could be replicated, it is unlikely they could be replicated in any but some urban areas. And if they could, the transition cost in most markets would be immense, and who would pay for that? (the new Mayo Clinics are in high growth and very prosperous areas, Florida and Arizona)

Can we learn anything from these clinics. Possibly yes. Can we duplicate these models in other areas? Not likely, and certainly not in the near term.

The Status of Reform

As of today, there are as many as five (5) plans active in Congress, President Obama is getting impatient, Congressional leaders are counseling patience, and no one knows if any action will be taken before the August Congressional recess.

Stay tuned.

Battle of the (Senate) Titans

Senators Kennedy (Chairman of the Senate Health, Education, Labor and Pensions Committee) and Senator Dodd (Kennedy’s wingman while he fights cancer) are seemingly lined up as opposition forces to Senator Baucus (Chairman, Senate Finance Committee ) on some aspects of health care reform legislation. Various theories are evolving:

1) this is a real dispute
2) this is a clever ruse to allow a compromise that gives political cover to all types of Democrats
3) this is just some foreplay designed to allow Kennedy to be a hero one more time, with serious cred to Baucus, a rising power in the Senate
4) some combination of #1 - #3


Kennedy and Dodd’s latest: http://dodd.senate.gov/?q=node/5062/print

Medicare Bundling

The federal government is concerned about the incidence of Medicare re-admissions.

Typical scenario: an elderly patient is admitted to the hospital for pneumonia and related distress. After a four day stay the patient is discharged to a long-term care facility.

A week later the patient is re-admitted with acute distress, after the nurse requests orders from the patient’s physician. After several days the patient is again discharged to the nursing home.

This cycle is very costly to Medicare, and the feds would like to see it slow down.

(Based on conversations with long-term care nurses and reviews of Minimum Data Set (MDS) summaries, the patients are usually very old, very frail, but not at death’s door quite yet.)

One solution is to ‘train” physicians and families not to be so quick to send the patient back to the hospital. This is tough on families, who often pressure the physician to readmit. Sometimes the patient demands readmission, it is easy for the physician to say yes. This can also be tough on the nursing home, where higher acuities are colliding with the nursing shortage.

A proposed solution is bundling. President Obama mentioned it in his 6/15 speech to the AMA. How does it work? The hospital gets a flat fee per incidence and then has to pay the physician, nursing home, ambulance/transport company, physical therapist, etc.

This requires a lot of administrative work and some intense negotiations, and puts the hospital at significant risk.

Could this work? Maybe. Is it good for Medicare? Probably yes. Good for patients? Unknown. Good for physicians? It depends. Good for the nursing home? Doubtful.

Fast and Furious

No, not the movie - health care reform.

In recent days:

• President Obama, in his Saturday radio address, promised to get hands on the issue.

• Senator Kennedy let draft reform legislation float around, creating the appearance that he is stepping in front of Senator Baucus.

• Senator Kennedy and Senator Baucus issue a statement about how well they are going to work together.

• The possible tax on health care benefits bubbles to the surface once again, as do possible taxes on sodas, beer, wine, and other sinful pleasures; other possibilities include taxes on securities dealers, life insurers and elimination of certain estate planning practices.

• President Obama lets it be known he wants to tax the rich, not working people, possibly via deduction caps (Axelrod and Goolsbee floated this trial baloon on the Sunday talking head shows).

• The House is circulating a proposal with an almost mandatory coverage rule, and penalties for anyone with the means who refuses to buy health insurance (?). All non-group policies would be channeled through a federal policy exchange. A spokesmen for Rep. Waxman made clear the circulating drafts are not the official work product of any committee.

More on this as the trial baloons become more official.

Selling Health Care Reform

President Obama is selling health care reform with the argument that we need to fix health care in order to fix the overall economy.

Economic advisor Christina Romer distributed an op-ed piece today explaining how health care reform would 1) improve family incomes, 2) enhanced GDP, 3) lower budget deficits, 4) lower unemployment, 5) provide greater health care coverage (of course) and a 6) better labor market.

Wow. This is quite a claim.

Full report: http://www.whitehouse.gov/assets/documents/CEA_Health_Care_report.pdf

Paying for Health Care Reform

President Obama’s ambitious health care reform plans may have run into an immovable object – money.

In order to move forward on his plan the President has to find and/or reallocate something on the order of a trillion dollars or so.

One means of expanding health care coverage while containing health care costs is “efficiency” a fuzzy and hard to predict concept at best, especially while expanding insurance coverage.

Other potential means are been discussed by various constituencies, in no particular order:

Taxing the rich (also discussed to solve the deficit and other problems)

Tax some or all employer-paid health care benefits

Tax soda

Tax all sorts of “sin” products

Broaden the Medicare tax base

Cut payer reimbursements, possibly offset by insuring most Americans

Create new reimbursement systems for providers, perhaps “outcomes based”

Reduce or eliminate the tax sheltering benefits of Flex Savings Arrangements (FSAs)

Alter Health Savings Accounts (HSAs)

A national value added tax (VAT) or sales tax


Accomplishing this in the midst of a nasty and deep national recession may prove to be difficult if not impossible, but it appears Congress is going to move ahead and give it a try in the next few months.

Now or Never

as reported today by the Associated Press

President Obama, on a conference call from Air Force 1 with a coalition of supporters, warned that if health care reform is not accomplished this year it may never be.

(Ed: Never is a long time .......)

Obama is trying to enlist his political organization, Organzing for America, active and engaged in the political process.

Obama is leaving the details of health care reform to Congress, apparently having learned something from the 1993 mistakes of the Clinton administration, which did an end run on Congress.

Rationing or Evidence-Based?

Medicare has decided not to pay for virtual CT colonoscopies.

Medicare does cover regular invasive colonoscopies.

The x-ray procedure is a substitute for invasive colonoscopies. It is cheaper and non-invasive, but does involve x-ray radiation.

The invasive colonoscopy allows the surgeons to excise any pre-cancerous polyps found, saving a second procedure.

If the CT colonoscopy finds pre-cancerous growths, then a regular colo must be done to excise the polyps, thus causing two procedures instead of one.

Medicare does point out that the Medicare population, almost all of whom are 65 and over, may not be a good indicator for the under-65 population. Medicare is willing to look at future data.

These are the sorts of dilemmas health insurers must wrestle with. No decision will make everyone happy.

Rationing or evidenced-based medicine? Depends on your point of view.

Tax Discussion Update

May 12, 2009 - from the AP

Senators weigh tax hikes to pay for health care

By RICARDO ALONSO-ZALDIVAR, Associated Press Writer Ricardo Alonso-zaldivar, Associated Press Writer 1 hr 12 mins ago

WASHINGTON – Senators are considering limiting — but not eliminating — the tax-free status of employer-provided health benefits to help pay for President Barack Obama's plan to provide coverage to 50 million uninsured Americans.

Finance Committee Chairman Max Baucus, D-Mont., said Tuesday that there are no easy options. Senators began grappling with how to finance guaranteed coverage, a cornerstone of Obama's plan to overhaul the health care system. Independent experts put the costs at about $1.5 trillion over 10 years......

The Great Tax Debate

Employer-paid health insurance is usually a non-taxable benefit to the employee. IRC S106.

Over the years this “loophole” has popped up in various discussions of tax fairness and expanding health care coverage.

The Obama administration has floated various trial balloons, and Senator Baucus (D. Montana), an influential player in the health care reform debate, thinks the time for change may have come.

Rep. Charles Rangel (D. New York) a veteran representative and powerful chairman of the House Ways and Means Committee says simply, “no way.” All tax legislation originates in Ways and Means.

Candidate Obama criticized John McCain for proposing the taxation of health insurance benefits, but advisors to President Obama will not close the door, including new DHHS secretary Sebelius.

President Obama needs a major funding source to help close the deficit and to provide a $600M plus health care reserve fund.

Some labor unions fiercely defend the tax break, as middle class union members would be hit hard by a tax on health insurance benefits.

(Using real tax family returns and creating pro formas by adding policy amounts, the tax increase could range from about $1500 - $5000, depending on the structure of the tax, the possible applicability of FICA and Medicare taxes, and the taxation policies of state and local governments.)

In theory, employers would save some money because enhanced government programs would slow or eliminate “cost shifting” from the uninsured to the insured. However, employers might end up paying higher matching FICA taxes. Employees would be unlikely to see any of the savings (if any).

This could be a nasty debate, with some strange bedfellows.

Electronic Medical Records Held for Ransom

A drama is playing out in Virginia as computer hackers claim to have hacked a data base used to monitor patients for prescription drug abuse.

The hackers are demanding a $10 million ransom for the data, or the data goes on the internet.

Virginia health officials and the FBI believe the threat may be credible.

The future of EMR?

Swine Flu

The United States government declared a public health emergency Sunday as the number of identified cases of swine flu in the nation rose to 20.

From Reuters:

"WASHINGTON, April 25 - A new and unusual strain of swine flu is likely widespread and impossible to contain at this point, experts agree.

The H1N1 strain has killed at least 20 people and possibly 48 more in Mexico and has been confirmed in at least eight people in the United States, all of whom had mild illness.
Probable cases also were found at a school in the New York City borough of Queens and experts at the U.S. Centers for Disease Control and Prevention say they fully expect to find more cases."



This strain of influenza spreads easily from person to person, has been diagnosed in several places and some victims have had no known contact with carriers. Not pretty.

Military - VA Medical Records Plan

President Obama wants to create a Joint Virtual Lifetime Electronic Record that would streamline the transfer of active-duty military and veterans' health records between the two departments.

Given the targeted patient demographic this might be an interesting test of electronic medical records capability.

OSHA Workplace Violence Procedures

The tragic shooting spree at a Carthage North Carolina nursing home is a reminder of the OSHA requirement for a workplace violence program, applicable for not only nursing homes but other health care providers as well.

No program can stop a crazy killer or an armed robber, but training employees to react properly can hasten the arrival of police and the protection of residents.

This should also be a reminder that facilities open 24/7 have special issues with security and safety.

OSHA fact sheet:

http://www.osha.gov/OshDoc/data_General_Facts/factsheet-workplace-violence.pdf

Veterans Care Fiasco - Disaster #2

More than 3000 southern Florida veterans are being called in for infectious disease testing after tubing on colonoscopy equipment was found to be improperly sterilized.

This follows a similar colonoscopy problem in another region, and another recent problem with ear-nose-throat equipment.

The care standards for these procedures are quite well known, and the number of exposures indicates a serious management problem (as opposed to a batch or two of sterilization problems, which can happen).

Odds of infection should be low, but low is too high for those infected.

VA Policy Proposal - Disaster #1

Last week the Obama administration floated a lead-filled trial balloon.

The administration proposed that a veteran's care could be billed to a vet's private insurer in some cases, raising $500M a year.

The feedback from veterans' groups and Congress was swift and ugly.

Veterans' feared losing private insurance coverage, and members of Congress proclaimed veterans' care a convenant not to be broken.

The administration moved on to other topics - quickly.

The Lastest in Physician Office IT

Who will lead the charge to install IT in physician offices?

Sam's Club and Dell.

Huh?

Sam's Club will partner with Dell and eClinicWorks for software, hardware, training and maintenance. No joke.

The system will integrate patient appointments and billing (the billing modules are ultra-complex and carry significant risk of major problems).

Wal-Mart has some experience with health care IT, primarily in pharmacy and optometry. WM also has used the software in a limited number of redi-clinic settings (which are much different than a regular physician office).

Does Wal-Mart understand the complexities of physician office operation and the vagaries of dealing with physicians?

The $20B stimulus money had to attract a lot of vendors, this may be the surprise leader of the pack.

Tires, lettuce, underwear, health IT. Such a concept.

Hat tip: International Herald Tribune 3/11/2009

More Blogging

It has become clear, this blog will be dominated by health care reform and public policy.

The management issues we want to discuss simply cannot be woven in here.

So...................

A new blog, http://practicemanagementnews.blogspot.com/ will focus on management issues and regulatory matters. There will be some cross posting.

Spread the word!

Rediscovering the Nursing Shortage

Another administration discovers the nursing shortage.

http://www.reuters.com/article/domesticNews/idUSTRE5270VC20090308

http://news.yahoo.com/s/nm/20090308/hl_nm/us_usa_nurses

Proposal: the federal government should channel funds to colleges and universities that provide programs we need, rather than graduating more Ph.D.s in overcrowded disciplines.

Nursing - high stress, bad hours, physical exertion, exacting standards, little respect.

Failure to warn

The U.S. Supreme Court settled a major liability issue in Wyeth v. Levine this week.

A patient was given an IV push dose of Phenergan, apparently the administration was done in a negligent manner and the medicine entered an artery, and the patient lost her arm.

As best I can tell there was no allegation that Phenergan, a widely used drug, was hazardous, but that the drug maker Wyeth should have provided better warnings about what could happen if an IV push administration was done improperly.

(I checked with my favorite nurse, who tells me that she doesn't need to be warned not to put an IV into an artery, as she said "what do you think the "V" stands for." Nurses rarely read warning materials on commonly used drugs anyway. Just one opinion. She does administer Phenergan regularly, although not via IV.)

The legal argument?

Wyeth claimed that since the FDA had found Phenergan to be safe and effective, and because the FDA has approved very precise language on the label, there was no duty to provide further warnings and no ability to unilaterally rewrite the warning materials.

SCOTUS says the state could find a duty and that Wyeth could have unilaterally changed the labeling.

So what does label approval by the FDA mean today? How far does the unilateral rewrite authority go? What if the FDA disagrees with the unilateral rewrite.

From a liability standpoint, how much liability should a drug or device maker have for provider malpractice?

Interesting questions.

Voodoo Finance

Governor Strickland of Ohio is going to increase his Medicaid available funds by -- taxing health care providers, specifically hospitals, nursing homes, MR facilities and managed care companies.

Huh?

Dirty little secret -- some states use "bed taxes" or "provider taxes" or "provider fees" to generate match money for federal Medicaid funds, a maneuver which is legal but on shaky ethical grounds. This is "dog chases tail" gimmick financing. Who is to blame? Fed reform of Medicaid would help.

A nursing home will pay the "tax" on all licensed days of service, but will be reimbursed for the "tax" only for those days used by Medicaid recipients. This amounts to a tax on all residents not funded by Medicaid, what the federal government calls cost shifting.

When criticized for using stunts and gimmicks to balance the budget (and avoid restructuring the government), Strickland uses the everybody else has done it defense.

To be fair, the states have many difficult budget decisions. This is not a healthy balance budgeting tool, especially after the feds pouring stimulus money into the states.

For more details, excellent reporting in the Columbus Dispatch.

http://www.dispatch.com/live/content/index.html

Secretary of DHHS

Kansas Governor Kathleen Sebelius has accepted an offer to be Secretary of DHHS.

Change We Can Believe In?

No one can claim President Obama is timid!

His new budget plan, or at least what we know so far, appears to make some bold moves on health care reform.

Stay tuned for detailed analysis, as details are available.

Stimulus Part IV

The concept of "effectiveness review", in general, states that payers (and especially the government) should not pay for drugs and procedures not already proven effective.

(The political theory is private payers will take the lead and refuse to pay for anything not paid for by Medicare and Medicaid.)

Question: if the drugs and procedures are not paid for, and clinicians do not use them, how do we compile the evidence of effectiveness?

For drugs we do have clinical trials, but many physicians are more convinced when they see the effectiveness in clinical practice.

For surgical techniques and hardware, most progress has been made with years of trial and refinement (such as the immense progress in orthopedic joint replacement).

Will we slow innovation? How will we balance cost versus progress?

Stimulus Plan Part III

While we wait for six more inches of global warming to be cleared from Michigan's highways..... (8 feet so far this year).

Who is spearheading the "effectiveness review" concept inside the Obama administration?

Peter R. Orszag.

Orszag is Director of the Office of Management Budget for the Obama administration.

By all accounts he is a brilliant economist, and an expert on retirement issues.

Best I can determine, he has little or no background in health care.

We love economists here, but wonder about health care reform being driven by economists.

Time will tell.

Update: Apparently Orszag did some HMO consulting during a stint with McKinsey and Co.,

Stimulus Bill Part II

Why is the stimulus bill (H.R. 1) more than 1000 pages?

More than 200 of those pages are health care reform, including a massive health care IT plan.

How much time was spent debating the largest health care reform plan of the past two decades?

None.

Also included are updates on HIPAA security and privacy, and perhaps the provisions that will shape the future of U.S. health care, the "effectiveness review" plan. I just reread Tom Daschle's book, and his brief stint as almost-Secretary allowed him to have immense influence.

In front of me is a full 3" ring binder, perhaps containing the future of our health care system, perhaps not.

First, a few days with the grandchildren. Then, the work continues in earnest.

Update: I was curious. Printed in pieces from the Thomas site, I have 261 pages.

Stimulus Bill Part I

I spent my Saturday working through the stimulus bill, which looks more like a health care bill with a stimulus package attached.

Printing the health care sections nearly burned up my printer.

Look for analysis coming almost every day.

Surprise - Congress revisited HIPAA, just to add work and confusion to the situation.

The Ghost of Tom Daschle?

Recent news reports and commentaries on the stimulus bill allege the bill contains many of the bureaucratic recommendations of former DHHS nominee Senator (retired) Tom Daschle.

This is still developing.

In brief, Daschle wanted massive government data bases of patient information combined with a board to determine which treatments and medications physicians could order for government patients.

More as this develops.

Secretary of DHHS?

The Associated Press is reporting today that Kansas Governor Kathleen Sebelius may be the leading candidate for the Secretary of DHHS.

Sebelius had reportedly been considered for this and other cabinet posts before Tom Daschle was slotted for DHHS. Daschle melted down in a tax controversy.

Sebelius was Insurance Commissioner before becoming Governor, a back ground that would be helpful in the job.

Sebelius has deep roots in the Democratic Party, her father was a liberal Governor of Ohio.

This appointment is not assured. Stay tuned.

Daschle Withdraws

CNN is reporting that Tom Daschle, beset with tax and potential conflict problems, has asked to wtihdrawn from consideration as Secretary of Health and Human Services.

Developing, pending further confirmation.

Update: AP confirms

News Flashes

Senator (retired) Tom Daschle was on a fast track for confirmation as Secretary of Health and Human Service (and to be a sort of health care reform czar) when his tax returns jumped up and bit him.

Daschle was working as a $1M a year "consultant" to a media private equity fund run by his friend, and receiving free car service, a very substantial benefit in Manhattan's gridlock.

Reports say on one return Daschle forgot an $89k consulting payment, as it was excluded from his Form 1099 (how does an accountant not multiply 89 x 12?).

The Daschle's paid the back taxes this year with interest, but are also reported beneficiaries of a special influential insider penalty waiver by the IRS (how sweet).

Time will tell.

UPDATE: The Daschles may have to re-amend their tax returns. Developing....

In other (better) news.....

Professor David Cutler of Harvard, an influential voice in health care reform discussions, has been selected to serve as a health care advisor to President Obama.

Tom Daschle's health care book - Part III

Five functions of the Federal Health Board

1. set rules for the expanded Federal Employee Health Benefits Program

2. promote "high value" medical care, i.e., recommending coverage of drugs and procedures backed by solid evidence, and ranking services and therapies

(how we gather this evidence for new drugs and procedures is not exactly clear)

3. align incentives with high-quality care

4. increase transparency

5. play a role in nationalizing (his words) our health-care infrastructure  (although he then proceeds to discuss resource allocation rather than infrastructure)

Solid proposal or cliche' fest? Discuss.

Pages 171-178

Tom Daschle's health care book - Part II

Senator Daschle wants to build on the current private system, but also expand the scope and reach of federal government programs.



The Federal Health Board, modeled after the Federal Reserve Board, would initially be directed at the federal government programs, but Daschle makes it clear that with enough influence the FHB would assert signficiant control over the entire U.S. health care system.



"I believe a Federal Health Board should be charged with establishing the system's framework and filling in most of the details. This independent board would be insulated from political pressure [emphasis mine] and, at the same time, accountable to elected officials and the American people. This would make it capable of making the complex decisions inherent in promoting health system performance. It also would give it the flexibility to make tough changes that have eluded Congress in the past." (page 169)



"The Federal Health Board would have regional boards that would have a say in national decisions, but would focus primarily on promoting best practices and quality of care locally...... Over time, the regional boards might assume other roles, such as ensuring an adequate supply of certain services or linking payments to performance....." (page 170)

Next post, the five functions of the proposed FHB.

Tom Daschle's health care book - Part I

Senator (retired) Tom Daschle, new Secretary of the Department of Health and Human Services (and health care czar!?) wrote a book in 2008 about the health care system (before he knew about this position I believe).

Given Daschle's major influence in the new administration, I am studying the book to look for insights into possible reform plans.

(Daschle has been working at a DC law firm which also does lobbying, but Daschle was apparently kept insulated from the lobbying operation.)

We open with something v-e-r-y interesting. From the dustcover....

"Daschle's solution lies in the Federal Reserve Board, which has overseen the equally complicated financial system with great success. A Fed-like board would offer a public framework within which a private health care system can operate more effectively and more efficiently - ...."


To be fair to Daschle, I believe this book was written before the current financial meltdown, but this concept is a little scary. More in the next post.



Critical: What We Can do About the Health-Care Crisis - Daschle, Greenberger, Lambrew, Thomas Dunne Books, St. Martin's Press, 2008

Billing News - Technical Pronouncements

ICD-10 HIPAA transaction standards

The current set of outpatient diagnoses codes, the International Classification of Diseases, 9th edition, Clinical Modification (ICD-9-CM) will be replaced by the tenth edition (ICD-10-CM). Physician practices and others must begin submitting ICD-10-CM diagnoses codes by Oct. 1, 2013.

Administrative transactions standards

CMS released the final rule mandating the latest set of administrative transactions standards as part of the Health Insurance Portability and Accountability Act (HIPAA). The ASC X12N 5010 standards replace the current ASC X12N 4010A1 version of the electronic transactions standards. CMS has set Jan.1, 2012, as the compliance date for the 5010 standards.

Comment:

These will require an immense amount of work by provider and tech geeks to make this work.

The government's attempts to make health care billing totally incomprehensible continue apace.


(Sources include Modern Healthcare and the Medical Group Management Association.)

Daschle Confirmation Hearings

The hearings for Secretary of DHHS (and health care czar) start this morning. So far it is a love fest.

I have picked up Daschle's book and will have a post on that soon.


Update:

The usual preening by Senators, followed by Daschle's assurances that he can fix any problem.