September 2009 Archives

Here's a little something that's not really being covered. So, what do you doctors think about abstinence-only education programs?

From the Salt Lake Tribune:

A Senate committee voted late Tuesday to bring back federally sponsored abstinence-only education, tucking $50 million a year into the broader health reform package.

The Senate Finance Committee narrowly approved the amendment offered by Utah GOP Sen. Orrin Hatch on a 12 to 11 vote with Democratic Sens. Kent Conrad, N.D., and Blanche Lincoln, Ark., siding with the panel's 10 Republicans.

The amendment was approved over the objections of the committee's chairman, Sen. Max Baucus, D-Mont., who offered his own amendment that would create a program that would teach about abstinence, contraceptives and life skills, such as financial literacy.

Baucus's amendment -- with a price tag of $50 million annually -- also was approved by the committee.

Hatch and Baucus argued about the effectiveness of abstinence-only education programs, continuing a debate between the two parties that has gone on for years -- and because of the dueling votes will continue as part of the health reform debate. The amendments would still need to go before the full Senate and House.

President Barack Obama's budget calls for a comprehensive sex education program similar to that offered by Baucus, while phasing out the abstinence-only program vigorously supported by his predecessor, former President George W. Bush.

We haven't seen many smiling photos of Sen. Chuck Grassley lately, but Modern Physician has one:

Maybe he's smiling about this?

Physicians working in rural areas would see a boost in Medicare reimbursement as part of a bipartisan deal struck by members of the Senate Finance Committee and attached to a broad health overhaul bill.

The amendment, sponsored by Sen. Chuck Grassley of Iowa, the senior Republican on the panel, essentially adds more money to help defray the payment differences between providers in rural communities and those practicing in more heavily populated ones.

Under the amendment, HHS would adjust the practice-expense formula for 2010 and 2011 to better reflect the salaries and rents paid in rural communities.

The issue resonated with many on the committee because of their rural ties. But even senators from more populous states, such as Sen. Charles Schumer (D-N.Y.), voted to approve the measure because some areas in New York could benefit.

Or maybe this Tweet made him happy:

Full article (about the rural docs) at Modern Physician: Grassley amendment would boost reimbursement for rural docs

So, by now you know that the Senate Finance Committee rejected the two public option amendments. But what's next? From the Wall Street Journal Health Blog:

All of the panel's Republicans and a few Democrats voted against the measures -- one, from Jay Rockefeller, went down by a 15-8 vote; another, from Chuck Schumer, lost 13-10.

This is a major blow to what has been one of the most contentious elements of the health-care debate this year. All along, everybody's pointed to Senate Finance as central to shaping the health-overhaul legislation. And Max Baucus, the committee's chairman, maintained his opposition to the public option today, arguing that a bill that includes the public option wouldn't be filibuster-proof.

Nevertheless, this isn't the end of the debate over the public option. Bills approved earlier this year by three House committees and the Senate HELP committee all include versions of a government-backed insurance plan.

Given the disparity between the Finance and HELP committee bills, it's not entirely clear whether the bill that ultimately makes it to the Senate floor will include a public option. But the Finance Committee's bill is expected to carry great weight as Democratic leaders try to bring a bill to the floor.

If the legislation coming out of the committee doesn't include a public option, Democratic backers are likely to try to tack one on. And if the full Senate passes a bill that doesn't include a public option, but the full House passes a bill that does include one, the fight could go all the way to the conference committee, in which the House and Senate hash out a final bill to send to the president.

CNN reports that Sens. Rockefeller and Schumer will "put their Democratic colleagues on the spot [today] by offering amendments on whether to give uninsured Americans the opportunity to join a government insurance program." More:

It's not clear whether the two Democrats have the votes on the committee to get their amendments passed. But it is clear that the debate could be contentious, if last week's discussion was any indication, with Republican Sen. Jon Kyl of Arizona banging his fist on the table in an effort to be heard. ...

The Congressional Budget Office estimated that the House bill would cost $1.1 trillion over 10 years, but Obama told Congress he wants a bill that costs $900 billion.

Democrats -- the majority in Congress -- are looking at adding a tax on insurers as a way to reduce the overall price tag of their health care bill. ...

Democratic Sen. Max Baucus, the committee chairman, who recently unveiled his proposal, has said his bill comes in at $900 billion.

It would require all Americans to have health insurance but lacks a government-run public health insurance option and has proposed using health care co-operatives.

Rockefeller has signaled he will not support Baucus' bill as it stands.

Also:

• A recent New York Times/CBS News poll found that 65% favored a public option, with only 26% opposed to it.
• To put that number in perspective: a 2007 Associated Press/Ipsos poll found that 34% of Americans believe in UFOs.

(From Media Matters)

From the Wall Street Journal Health Blog, we read of "perhaps the largest effort so far of any hospital system" to establish an EMR system, and the financial carrots going along with it:

In the push to get doctors to digitize their patient records, one New York hospital system is going to dangle a $400 million carrot. The North Shore-Long Island Jewish Health System is planning to offer doctors who establish electronic medical records up to $40,000 annually for five years, according to the New York Times.

The subsidy would come on top of the $44,000 that doctors could get as part of the federal stimulus package to further decrease the expense of digitizing records, whose costs can be substantial.

The system, which has 13 hospitals and more than 7,000 doctors, wants to set up a system to share data between doctors' offices, labs and hospitals in order to better coordinate treatments, while cutting unneeded testing and reducing errors. The plan is to offer more money to those docs who are willing to share more information, including anonymous patient data on procedures and treatments. ... In addition to better patient care, EMR systems can strengthen ties between doctors and hospital groups, perhaps giving those hospitals an edge in the competition for doctors with admitting privileges to multiple facilities.

Electronic records, anyone? Hey, what's going on with HIPAA these days?

From The Tennessean, Tennessee gave doctors wrong fax number in privacy breach / Patients' private medical records faxed out of state:

The Tennessee Department of Human Services said it accidentally sent the wrong fax number to 100 medical providers across the state, leading them to erroneously send sensitive patient information to an Indiana businessman.

"We're extremely embarrassed, and we're working to remedy the situation," said Michelle Mowery Johnson, spokeswoman for DHS. "We hope it doesn't happen again."

The state sent an e-mail blast to 29,000 medical providers with the correct toll-free fax information on Monday.

The problem was first reported by The Tennessean.

Bill Keith, owner of SunRise Solar Inc. in Indiana, has been receiving hundreds of confidential medical faxes from doctors' offices and other medical providers in Tennessee for three years.

Keith was, on Monday, still receiving patient information meant for the Tennessee Department of Human Services in Nashville. Keith has tried to correct the problem with the state and doctors' offices but to no avail.

On Friday, state officials blamed doctors' offices, saying that the toll-free fax numbers for Keith's business and the state nearly match. But Monday, Mowery Johnson said the state was taking some responsibility for the problem, which stemmed from a typing error.

It was a new caseworker in the Disability Determination Section, under DHS, who sent a cover sheet with the wrong fax number to medical providers, Mowery Johnson said. Also, the state can't change the fax number because it belongs to the Social Security Administration, which handles the disability checks, Mowery Johnson said. Changing the fax number would affect thousands of people, state officials said.

Keith said the state suggested that he change his fax number but he can't because he fears it would negatively affect his business.

"People in Tennessee ought to be concerned, and there will probably be a public outcry," Keith said. "This shows the inefficiencies in our system. Doctors' office have been rude to me on this issue when I try to point out the problem."

Image: Old fax machine, Vintage Telephone Equipment Museum, Seattle, Wash.

I was watching The Office the other day and caught the writers sneaking in a pro-health care reform message:

The Los Angeles Times gives us our weekend update on where things stand in the House and the Senate, Q+A-style:

Where do the various healthcare bills stand now?

There's a single House bill that will go to the floor when Speaker Nancy Pelosi (D-San Francisco) deems it politically expedient. That is expected to happen in October. Pelosi will probably wait to see what the Senate produces before she subjects her caucus to a vote, because many Democrats are nervous about the way the bill will play back home. She also has to worry about whether the centrist Blue Dog Democrats will support a more liberal bill.

In the Senate, one version of a healthcare bill has been passed by the health, education, labor and pensions committee. Another is working its way through the finance committee.

What's up with that bill?

That is the Baucus bill, which has garnered so much recent attention. Finance Chairman Max Baucus (D-Mont.) wrote his version of a healthcare overhaul, which was notable for receiving criticism from just about every side. So Baucus has subjected the bill to a markup, in which the rest of the 23-member committee is given a chance to revise the legislation through amendments. When the process started last week, there were more than 500 amendments waiting to be offered. One week later, nothing much has changed.

Why?

The markup has given Senate Republicans a platform to air their grievances over the Baucus bill. The GOP has used the process to complain about cuts in Medicare, whether healthcare would be rationed, and whether the bill would be transparent enough.

How are Democrats proposing to change the Baucus bill?

Plenty of Democrats are unhappy too. Their concerns revolve around the level of federal support for low-income Americans who would be required to purchase health insurance. But addressing those concerns would significantly affect the cost of the bill. There will also be an effort to insert a provision creating a government-run insurer to compete with private companies -- the so-called public option.

What is the conflict over Medicare?

Republicans have seized upon statements by President Obama and others that there would be no cuts in Medicare services for seniors, despite the fact that Democrats have vowed to shave hundreds of billions of dollars out of the entitlement program.

In particular, Republicans say that the Democrats' plans to trim payments to providers who accept Medicare Advantage, a private insurance program, will result in reduced services. Democrats say that they are simply trying to reduce the gap between payments to the Advantage program and payments to providers in regular Medicare, and that services won't be affected. It's clear, however, that this is a sensitive subject, as Democratic senators from states such as Florida and Oregon, where Medicare Advantage is popular, are looking for ways to preserve the program as it is.

When will there be a final Senate bill?

The clock is ticking. Senate Democrats have until Oct. 15 to use reconciliation, a procedure that allows passage of budget-related matters by a simple majority. Last week, Majority Leader Harry Reid (D-Nev.) warned Republicans that he would use the tactic if they remained recalcitrant. But that would be politically risky. Even if a bill passes the Senate by mid-October, it would have to be reconciled with the House bill in a conference committee. That could take weeks.

We mentioned the Investors.com physician poll a while back. For the final installment of the series, Investors.com has listed 1,278 doctors' comments verbatim: why they either support or oppose reform.

A quick snapshot of the results:

Nearly 65% opposed government proposals then under consideration, and 33% were in favor. Two percent didn't answer.

Two-thirds of the reasons cited for opposing the government's plans fell into four categories. Twenty-four percent were directed at the government itself -- that it has a poor record in running major programs, for example, or that it would interfere too much in the doctor-patient relationship.

Another 16% cited the proposals' cost and the impact on the federal deficit and debt. Each of two other concerns garnered 14% -- quality of care and a lack of limits on physicians' exposure to malpractice lawsuits.

Seventy-two percent of the reasons in favor of reform also fell into four categories. A too-long-neglected need to cover uninsured and underinsured Americans was cited by 22%. Seventeen percent simply said health care is a right, not a privilege.

Another 17% said the current system either doesn't work or is "unsustainable," and that any system would be better. Sixteen percent said reform is needed to make insurers more accountable and competitive.

And, for fun, if you'd like to read the actual comments, visit Doctors Verbatim On Health Care Reform. You'll see short explanations, like:

Oppose: Lower income for doctors.

and

Oppose: Socialism doesn't work!

and

Oppose: I oppose it strongly. It funds an abortion mandate.

And longer ones:

Support: Excessive administrative costs and executive compensation of private insurance companies who engage in recession. They fail to provide adequate information and pricing to people and they raise premiums unjustifiably. We need all legal citizens and legal immigrants to be covered. Aside from everything else, it is immoral to not make access to care available. This does not mean condoning lifestyles in opposition to good health (such as tobacco smoking, excessive imbibing of alcohol or engaging in various risky behaviors).

Support: Too much abuse in the current system. Eliminate all HMOs (and PPOs) -- they are a disgrace to the medical profession, They turned medicine into a business, rather than art and science. Copy the French system. It works very well -- no intermediary between doctor and patient.

The New York Times' Prescriptions column features Dr. John C. Lewin, chief executive of the American College of Cardiology, today, on "A New Way to Pay Physicians." An excerpt follows; read the full Q&A here.

Q. What's wrong with the way physicians' pay is structured now?

A. We have built our system on a payment model that rewards volume. Doctors get rewarded for more tests, more volume, more hospital admissions, more visits. There are no incentives for quality of care or administrative efficiency. That's part of why our system is more expensive than other nations.

The good news -- and the reason why I'm excited about health care reform -- is that the best health care in this country often tends to be very affordable. The whole discussion about bending the cost curve can be resolved by setting new incentives in payment that reward better outcomes with evidence-based medicine.

Q. The Cleveland Clinic and Mayo Clinic pay doctors a salary rather than fee-for-service. Is that what you mean?

A. At the Mayo Clinic, Cleveland Clinic, Kaiser Permanente and other integrated systems, doctors are salaried to improve quality. They're unfettered from having to deal with the dizzyingly complicated current payment systems. And they can do it precisely because they have an integrated system.

But about 85 percent of the U.S. health care system is not integrated. Instead, it's divided between small practices and community hospitals that aren't linked together with incentives to coordinate care. In the hand-offs that occur between hospital care and outpatient treatment, patients sort of get lost in the shuffle. That's one reason why 27 percent of patients with heart failure are back in the hospital one month later. They often don't have the medications right or in hand, or they don't understand what they need to do to help take care of themselves.

Even between the internist or family physician who generally manages a heart patient and the cardiologist who occasionally consults on the patient, you don't have the coordination that should occur -- unless you're in one of those integrated systems, with electronic health records and incentives for coordination and quality.

Q. What can we do to remedy the situation?

A. In Senator Max Baucus's bill [in the Senate Finance Committee], he proposed something called the C.M.S. Innovations Center. It would be funded with $10 billion over the next several years to implement pilot projects and demonstrations to promote new payment reform opportunities. There are quite a few problems with the bill, but this provision is truly visionary. The House legislation, HR 3200, mentions payment reform, but it [provides] only modest funding of $275 million. That's not enough.

Q. If this center were part of the federal Centers for Medicare and Medicaid Services, these pilot projects will be available only via Medicare and Medicaid, right?

A. Yes, for now. But we believe it will create incentives for higher quality care and will carry over to insurance companies. Medicare sets the stage for the whole system.

Q. So how would these demonstration projects improve integration?

A. We have to move from fee-for-service to creating virtual group practices that can become quality improvement networks. They would be organized around a registry that would help promote adherence to guidelines and evidence-based care. We've designed a prototype model that Medicare could use.

2015 sounds so, so far away. But I suppose it's really not.

From Modern Physician:

Physicians would see a difference in how they're reimbursed starting in 2015 and small, rural healthcare settings would be included in Medicare programs designed to better coordinate care under amendments attached to a broad Senate health reform bill on Tuesday. ...

The physician payment change, inked by Sen. Maria Cantwell (D-Wash.), would allow doctors to capture bonus payments for reaching a series of performance measures meant to streamline care throughout a practice group.

The idea is a version of a value-based index model, where doctors are rewarded for tamping down padded or wasteful procedures.

Under the terms accepted by the Senate Finance Committee, physician or physician groups would be eligible for a bonus payment based on the relative quality of care they achieve while treating seniors.

Full story: Reform bill amendments could benefit home health, doctors

(Tamp = to put a check on : reduce, lessen )

A little off-topic, sure. But here's Dr. John Clarke of Baldwin, New York, rapping about H1N1:

Why?

"On July 9th of this year, HHS Secretary Kathleen Sebelius announced a video PSA contest on flu prevention. Americans were called to create a 15, 30, or 60 second video promoting good hygienic practices and submit this video over YouTube. This video was to inform people about the flu and motivate them to take steps that help prevent the spread of the flu. The winner received $2500 in cash and is featured on national television." (From FLU.gov)

I'm impressed.