Excerpts from Monday's Supreme Court arguments

 

over whether legal challenges to President Barack Obama's health care law are premature under the Anti-Injunction Act, which bars lawsuits against a tax until after the tax is paid:

Solicitor General Donald Verrilli: This case presents issues of great moment and the Anti-Injunction Act does not bar the Court's consideration of those issues.

Donald Verrilli

 

Robert A. Long:  (amicus curae, friend of the court)

Somewhat to my surprise, "tax" is not defined anywhere in the Internal Revenue Code.

Justice Sonia Sotomayor:

Assuming we find that this is not jurisdictional, what is the parade of horribles that you see occurring if we call this a mandatory claim processing rule? What kinds of cases do you imagine that courts will reach?

Justice Antonin Scalia:

If it's not jurisdictional, what's going to happen is you are going to have an intelligent federal court deciding whether you are going to make an exception. And there will be no parade of horribles because all federal courts are intelligent.

Justice Stephen Breyer: What we want to do is get money from these people. Most of them get the money by buying the insurance and that will help pay. But if they don't, they are going to pay this penalty, and that will help, too.

Justice Samuel Alito: Today you are arguing that the penalty is not a tax. Tomorrow you are going to be back and you will be arguing that the penalty is a tax. Has the Court ever held that something that is a tax for purposes of the taxing power under the Constitution is not a tax under the Anti-Injunction Act?

Verrilli: No, Justice Alito, but the Court has held in the license tax cases that something can be a constitutional exercise of the taxing power whether or not it is called a tax. And that's because the nature of the inquiry that we will conduct tomorrow is different from the nature of the inquiry that we will conduct today. Tomorrow the question is whether Congress has the authority under the taxing power to enact it and the form of words doesn't have a dispositive effect on that analysis. Today we are construing statutory text where the precise choice of words does have a dispositive effect on the analysis.

All food for thought for every physician, and American

 

Technorati Tags: verrilli,scotus,obamacare,alito,breyer,robert long,scalia

Health Reform Updates

 

Monday  The Day At the Supreme Court

Will your line at the doctor’s office exceed the line at the Supreme Court on Monday?

Legal challenges to the Affordable Care Act finally come to the Supreme Court on Monday, when the public will learn for the first time what the justices ask about President Barack Obama's signature legislative achievement.

1200 pages and endless discord and argument now Does it all come down to two attorneys? 

As US solicitor general, Donald Verrilli is representing the Obama administration and will argue that the court should affirm the constitutionality of the ACA.

Washington lawyer Paul Clement is no stranger to the podium at the nation's highest court. To date he has argued 55 cases before the justices. He is representing Florida and 25 other states in their challenge to the constitutionality of the ACA's individual mandate.

As the high court begins three days of oral arguments over the constitutionality of the Affordable Care Act — the sweeping health care overhaul some call Obamacare — many legal and political experts agree the decision in HHS v. Florida will be among the most important in American history

*********************************************************

Premium Support in Medicare

Two Success Stories For Public Reporting Of Provider Performance Information

Why doctors aren’t prescribing health apps to patients

Study: Small medical offices lead in EHR adoption growth

U.S. leads many nations in health IT 

 

Patients recognize quality and security benefits of EMRs

The need for health IT workers is growing

We’ll expand further on these topics later this week.

Technorati Tags: affordable care act,supreme court,health reform,constitution,Paul Clement,Don Verrilli,ehr,health it,medicare

The New Social Media Paradigm in Medicine

Our patients are our allies in the pursuit of health and wellness.  This is no longer a euphemism. We have seen the onset of the new age….patient-centric medicine, the medical home, open access to information, even patient participation in medical meetings.

The twitter health care social media hashtag, use it to be heard.

Many others can be found here

Today, courtesy of Medpage Today, The American College of Cardiology broadcast a live webinar on heart disease.  The premise of the course was that, Patients who "see” their diseased arteries are more likely to lose weight and follow other ’heart-healthy’ advice. Graphic visualizations and angiography demonstrate changes from atherosclerosis and hyperlipidemia.   The topics included Late Breaking News from Clinical Trials of Stem Cells. (Texas Heart Institute), and analysis of Coronary Artery Calcium focused on patient compliance for achieving weight loss. Other topics included

The most successful physicians are the ones that accommodate those patients who are interested in bringing information to their visits.  Most of our patients are curious about their health and how we practice our art. Even if we are rushed for time it pays to receive their information openly and consider it for a patient by telling them you will need time to review the information and then respond with an answer. This does not have to occur during the visit.  This positive reaffirmation to a patient that their material will be reviewed is a powerful tool for patient awareness and compliance with anticipated treatments. Furthermore it builds confidence and expands the informed consent process for treatment protocols and/or surgical procedures.  The additional resources of references from the internet, library reference sources, and prepared brochures on commonly seen diseases should be made available for your patients.

Email attachments or twitter links sent to a patient can deliver the message when they arrive home or on the next day, saving office time, your time and staff time.

Technorati Tags: #hcsm,health social media,telemedicine,medpage today,cardiology,social media paradigm,twitter,hashtags

A Moronic Social Media Post on Health Train

(not meant to be a serious blog post)

The following discussions are ongoing in The Club Car. No jacket, tie or fee required for admission

Will Social Media help repeal Obama Care? 

Can Social Media reduce deficits, or save the Medicare trust fund?

Will your next health insurer be Facebook? Google? or Twitter?  It may be so.

Even now some companies have targeted their web presence linked to a Facebook.com/name url address as they position themselves for page rank in Google’s new algorithm.  The shear volume of traffic on Facebook makes it a ‘gateway’ landing page.  The sheer industrial size of Facebook’s servers would benefit anyone wanting to host their company’s web pages (gratis)  Just slip a link to re-direct a one line landing page over to your Facebook name page.

 

Check our formula for the answer:

Everyone wants your

 

One of the most well-known and effective copywriting formulas is the AIDA methodology. AIDA stands for Attention, Interest, Desire and Action. To write compelling copy, you should attract Attention, arouse Interest, stimulate Desire and present a call to Action. As marketing changes in the online world, I’ve found it more effective to change one component of the formula — Interest. Of course, you absolutely want your reader interested in your copy. But in online marketing, if you’ve done your job on the first step — Attention — by writing a killer headline that has gotten your reader to click on your article or scroll down to read more, you’ve already piqued their interest. Now what you should do to really sell or convince is show an Advantage.

The Ultimate D.I.Y. Repair toolkit :  Available Online from Amazon.com

What has any of the above have to do with Health Train Express? Just testing headlines and content for AIDA, which  stands for Attention, Interest, Desire and Action

Technorati Tags: aida,attention,interest,desire,action,health train express,robotic hands,do it yourself,facebook,google,twitter

<img src="http://cdn.shopify.com/s/files/1/0053/8772/files/The_Holstee_Manifesto.jpeg?105904" width="960" class="alwaysThinglink"/><script src="http://www.thinglink.com/jse/embed.js#190477988448436224"></script>

Learn on The Health Train Express Social Cruise

 

 

Relax and get your new tablet or ultra book or maybe even your ancient Dell Desktop, and follow along.

Social Media in Healthcare is a moving target. Like the stock market at times the best indicator is the moving average indicator. Social media sites grow rapidly, wane and flux and at the same time the user base shifts from platform to platform.

If you are a newbie, intermediate or advanced social-izer the best source for all learners or more advanced users is a Prezi course by Bertalan Mesko M.D.

The course is on Webcina and you can read about it here. Dr Mesko is an organizer from the get go. He has produced a great deal of content in social media in an articulate graphic and easily understood format.

For those of you who have never read or produced a Prezi presentation it will prove to be an interesting and captivating tool. The only other presentation tool I have seen or used that approaches Prezi is Pearltrees. Other useful slide deck platforms are Google Presentation and Slideshare.

Dr. Mesko has sixteen icons on the landing page, each a rich source for social media, bloggers, wikis, and stories about Google.

No matter where you are on the learning curve for social media, web search, rss feeds, Bert Mesko puts together an array of amazing tools. Each venture into his social media space nets me a wealth of new features.

Perhaps that is what makes social media so enticing to users. Each trip into the social sphere gains the user. I would definitely bookmark Webcina for easy reference.

 

Technorati Tags: bertalan mesko,health wiki,blogger,webcina,prezi,pearltrees,slideshare,google presentation,healthcare,learning

The California Health Benefit Insurance Exchange

 

California is a leading state in formation of Health Benefit Exchanges. The Health Reform Law as specified in the Patient Care and Affordability Act two years ago mandates the formation of Insurance Exchanges for each state to create a structure to make available plans for the uninsured or uninsurable.

California frequently goes where no man has gone before, or where others dare not trend. Unlike many states who have chosen to push back on federal mandates with legal means, or refusal to initiate a health benefit exchange, California is travelling down the tracks at great speed.

I took some time to sit in on a Webex presentation (archive available) of the recent California Health Benefit Insurance Exchange today. For those who missed it (probably 99.999% of my readers) The link(s) here will take you to an archive of the meeting. The Agenda is also here..

This is the second anniversary of the passage of the Affordable Patient Care Act. (2010)

                    

Important points of the California Health Benefit Insurance Exchange meeting follow:

Health provider and Public misperception is that the Health Insurance Benefit Exchange program is a government run entity. This is not true. The current involvement is a grant mechanism as a startup for HBIEs. This grant funding will end in December 2014, after which the HBIE must be self sustaining from it's own business model.

Should the state(s) decide not to build their own exchange, then the federal government has the option or mandate to do it for each state.

I thought it important for a physician to attend this meeting. I was unable however to attend the “executive session” which was not broadcast.

The development of the California Health Benefit Insurance Exchange is well underway.

Mission:: For all Californians to have Health Care. The CBHIE goal is to develop a marketplace

California's unique challenges

California is larger than most countries, and most states, with great diversity in income, rural/urban, ethnicity,languages, education,

California Timeline for plan and implementation relatively short.

Consumer centric: rural urban education

Exec Director Peter Lee

Business development..tracks

CBHIE Human Resource Needs for staffing

Qualified Health Plans by Price Waterhouse

CBHIE Enrollment System: Critical Backend IT platform

Assessing Federal Regulations

Setting standards for QHPs

Multi-state plans may be exempt from some requirements

CBHIE Will include dental plans, mental health,

Standard rates

At The Table was Donald Berwick MD former CMS head

Assessments:

Several shifts in Individual markets ,Group, Medi-Cal, Uninsured, Undocumented ? 1 million

Exchange prediction is working from vague statistics and estimates.

Enrollment penetration: 2014 20% 2019 100% Rates will be critical

Market surveys.

Beware of program  being construed as a 'government program”

Balanced approach, linked to health services

Spectrum of support services

Much of Health Benefit Insurance Exchange planning involves outreach and research into transitions, loss of employment, moves, divorce, connecting graduation, education, student loan program

Pre-enrollment from other plans from public programs, and for life transitions.

Technorati Tags: insurance exchange,california,uninsured,patient care and affordability act

Innovative uses of Health 2.0 and Social Media

 

Imagine a ‘Wiki” to empower patients

Several Health Wiki’s are already online.

WikiPublicHealth  (WiKiPH)  is  a U.K. based information source. It remains an open source for articles by anyone. It appears to allow anyone to register/log in/and create articles

 

 

HealthWikiNews is an already established site closely moderated by an advisory panel. It is hosted on WordPress.

Imagine that you have asthma, and rather than give you a set of instructions about what to do if you have an attack, your doctor invites you to help write them? Would that make patients feel more engaged and empowered in managing their health care, and would that ultimately make them happier if not healthier?

These questions are being raised by Dr. Samir Gupta, a respirologist at St. Michael's Hospital.

His research has found that a wiki - a website developed collaboratively by a community of users, allowing any user to add and edit content - can be an innovative new tool for developing individual asthma action plans.

West Wireless Institute: aggressively advancing the mHealth ecosystem

Founded by billionaire entrepreneurs Gary and Mary West, and guided by a blue chip laden executive team with all of the elements required to both think big and execute, the Institute has burst onto the scene in 2011.

There is no single organization worthy of mention in the same breath with San Diego-based West Wireless Health Institute when discussing the contribution of non-profit groups to the mHealth movement.

West Health Policy Center

West Wireless Health Council

West Wireless Health Fund

The opportunity presented itself to interview the Institute’s Chief Medical Officer Joe Smith, MD, PhD. During our conversation I was able to ask Dr. Smith about each of the projects and how they have progressed to date. The complete transcript can be found at the mHealth home page.

The organization also offers Fellowships.

More  trends in HIT, will they facilitate Health Reform by enabling cost reduction?

 

IBM has unveiled a clinical-analytics platform to provide doctors with insight into patients' conditions using natural-language processing and machine-learning capabilities similar to Watson.

 

IBM is moving on from "Jeopardy" to finding treatments using genetic data. The company announced it has developed a data-analytics platform called Clinical Genomics that uses algorithms and analytics similar to that of Big Blue's Watson supercomputer to find treatments for conditions based on a patient's genetic profile.

IBM's Clinical Genomics fits into the growing trend in health care of using big data to develop personalized medicine, which is the ability to use a patient's personal genetic characteristics to prescribe medical treatment for conditions, such as cancer, hypertension and AIDS.

Technorati Tags: ibm,watson,genomics,hit,health reform,personalized medicine,west wireless,mhealth,samir gupta,wiki

Who Reads Instructions?

Okay, I have always been an early adopter. And that extends to the recent introduction of Windows 8 (Metro)  Metro seems to be designed to be a GUI that is an enlarged smartphone screen. It is meant to be used on a touchscreen tablet.

Perhaps  Redmond intended Windows 8 to be sympatico with Windows phone users even though that market is still very immature and follows on a merger (purchase) of Nokia by MSFT.  Nokia as you will remember almost tanked with it’s now defunct Symbian OS. 

Loading the OS as a self installing .exe file from a USB stick was straightforward, even though it took several reboots and several long pauses with no indication whether it had crashed.  Patience paid off and the opening screen appeared. Warning the opening screen is a mono-color with a strange looking fish in the center. For aquarium lovers, you already realize it is a ‘siamese fighting fish’.  There must be some hidden meaning in that logo. Perhaps the code spells out Steve Jobs.

I bring this up on Health Train Express because there are probably many of you who are tempted to try Windows 8. I don’t think I would rush to use it for your office systems as yet. Reserve it for playtime.

Have no fear, despite the warnings of non support, I have not needed it thus far and have used it for almost three weeks.

I took out my backup insurance by copying all my important documents, photos, and personalized settings to an external hard drive and also to the cloud. In the past I have had some very bad experiences whereby a backup program in one OS was incompatible with a recovery in another new OS.  With that in mind, all went well, and because I use the cloud now for 90% of my computing both online and offline.

Beginning with blogger I have steadily migrated to more and more of Google’s offerings because of it’s synchronicity and it’s overlap of social media, document sharing, email and it’s android relationship.  In the near if Google’s chrome becomes more prevalent the need for Windows is less.

Because I blog and work in social media a great deal of the time, Chrome presents the most usable means of switching from Google + to twitter and Facebook.  The addition of Google Hangouts is the pudding in the pie.  Don’t forget YouTube as well.

Other than not working with my AIO HP all seems fine. It has a generic HP printer driver that shines. Printer drivers are the acid test for compatibilty, since printers are very finicky and exacting.

The only thing Google needs to do is develop a HIPAA compliant secure video conference and you have a low cost ready made teleconferencing solution that could alter the cost equation for healthcare.   What used to cost about 50,000 for a telemedicine set up now costs not much more than a laptop or tablet pc. P.S. it also works on a smartphone reasonably well.

Two projects in which I am directing are the use of it for a “Virtual Photo Walk” and “ Blind Veterans Help Desk”.  The later seems like an oxymoron, however I have a dedicated Veteran’s Advocate who convinced me it was worth a trial.  It seems useful for partially blinded patients to socialize.

Finally, I am glad I did not read the instructions, especially since there are no really official instructions, or accompanying help file.

It took about a week of experimenting with all the icons, buttons and learning to swipe using the mouse on a laptop. Microsoft promises a new $ 75.00 dollar swipable mouse pad in the near.

Technorati Tags: Windows 8,Windows Metro,blind veterans,virtual photo walks

Where do Health and Social Media Intersect ?

Online Health Care Discussions 98% Patient Driven

 

A bold statistic reveals how little medical providers are participating in the use of Social Media regarding health issues.

Recent statistics show that close to 90% of providers are familiar with or use social media such as twitter, facebook or google in their daily activities.

Dike Drummond MD writes on “HealthWorksCollective” and reveals that providers provide less than 2% of information except in the case of lung cancer where it jumps to a “whopping 9%” in online chat.  In a number of cases the majority of the discussion is driven by the patient’s caregiver. Alzheimer’s disease tops that statistic as you might expect.

The authors of this infographic focused on disease specific discussions and found the most discussed topics to be

• Depression
• Fibromyalgia
• Breast Cancer
• ADD
• Asthma
• Cardiovascular Disease

Infographic and article source:  NMCITE

[INFOGRAPHIC] 

Despite predictions about the adoption of social media for physicians in reality social media is more often used by caregivers.

There are opportunities for education and training of care-givers in health to enhance their efforts to support either their clients or their family using social media such as facebook, twitter, and Google +

Google + further enables social media with Google Hangouts affording a direct video conferencing ability amongst ten participants.

Further information is available at Digital Health Space on Google Plus.

Physicians should lead their staff in developing this modality.

Technorati Tags: digital health space,google+,social media,caregiver,physicians,dike drummond md,healthworks collective

ACOs Gaining Ground in Illinois

 

ACO is the hottest three-letter word in health care

Accountable care organizations take up only seven pages of the massive new health law yet have become one of the most talked about provisions. This latest model for delivering services offers doctors and hospitals financial incentives to provide good quality care to Medicare beneficiaries while keeping down costs. A cottage industry of consultants has sprung up to help even ordinary hospitals become the first ACOs on the block.

New Insurer-Hospital ACO Touts Early Success.

With only six months of data, the largest hospital system in Illinois, Advocate Health Care, and major health insurer Blue Cross Blue Shield of Illinois (BCBSIL) are declaring some early successes with its provider-payer accountable care organization, which is the largest commercial ACO, Scott Sarran, BCBSIL's chief medical officer, said in a Kaiser Health News article.

Advocate Health Care based in Chicago and BLBSIL's ACO called AdvocateCare has 250,000 PPO members and 125,000 HMO members, according to Sarran. In its first six months of 2011, the ACO resulted in hospital admissions per member dropping 10.6 percent, compared to 2010, and emergency department visits decreasing 5.4 percent, Kaiser Health News reported.

Even though the federal government offers under the 2010 health reform law a platform for Medicare ACOs, providers and payers have joined forces to create their own ACOs outside of the Medicare Shared Savings Program. For example, Hoag Memorial Hospital Presbyterian, Blue Shield of California and Greater Newport Physicians IPA just weeks ago announced its intent to create an accountable care initiative, and Pioneer ACO Atrius Health recently hinted in a FierceHealthcare interview that it is considering partnerships with commercial insurers, having already begun talks in reducing costs.
 

"If we're doing this in the Medicare arena, why can't we do this in the commercial environment, as well, and then be rewarded for the benefit we bring to the reduction in total expenses in Medicare PPO patients?" Atrius Health President and CEO Gene Lindsey said.

 

"Before, we were limited to the fee-for-service revenue that would be associated with caring for those patients. So this opens up a whole new vista in healthcare finance when we are looking for new ways to fully fund the programs of care that we want to offer," he said.

The administration forming ACOs will take considerable effort and startup costs amounting to several millions of dollars according to:

What are ACO start up costs ?

That's the"$64,000 question"

We have three separate estimates, with disparate figures.

The projected start-up costs of an accountable care organization (ACO) can vary widely, depending on who you talk to. The Centers for Medicare & Medicaid Services (CMS) estimates that it will take $1.7 million per ACO, based on a 2008 study of the Physician Group Practice Demonstration project, according to an Institute for Health Technology Transformation white paper released last week. The American Hospital Association (AHA), however, estimates ACO start-up costs are between $5.3 to $12 million, depending on hospital size. The Institute for Health Technology Transformation reports that it could take $7.5 to $11.3 million for a 200-bed hospital or $1 to $11.7 million for a 200-physician practice.

 

FierceHealth IT offers further details

 

Technorati Tags: accountable care,american hospital assoication,institute for health technology,medicare,ppo,kaiser health,advocate health care

We Won’t Know What’s In There Until We Pass It

 

When the Affordable Patient Protection Bill (APPA) bill was in congress many congressman could not or did not read the entire bill.  The bill was 1200 pages of the “Secretary of HHS” shall implement the following”…………..The bill was global, including many issues with health IT, public health, ACOs, and  set deadlines for implemenation without regard to the impact of each phase.

Some said that we would not now what was in it until it was passed.  That statement is probably the most true statement of the entire furor over health reform.

The initial phase included forbidding exclusions for previous illness and doing away with uninsurabilty as well as allowing dependent minors to remain on parent’s policies until the age of  25.  Those two items surely drove up the cost of health insurance.  Someone had to pay for insuring uninsurable people. Surely it sounds wonderful and it immediately reduced political pressure about health reform.

It may have been a bit backward to set up the financing after increasing the expense. I don’t understand the math but then again I don’t print money.

Jeff Young, at the Huffington Post describes it this way.

“The good news is that health care reform could lead your employer to put a little more money in your paycheck. The bad news is that if they do, it's probably because they aren't providing you with health insurance anymore.

The Congressional Budget Office estimates that 4 million fewer people will get health benefits from their employers in 2016 compared to what the agency projected a year ago. More people will end up on Medicaid, the government health program for the poor, and more companies will decide to stop offering health benefits and let their workers buy their own coverage through insurance "exchanges" the government will establish in 2014. The Congressional Budget Office doesn't estimate how much wages might increase for those who lose company health benefits.

How could this translate into bigger paychecks for workers? Economists consider health insurance to be part of how much companies "pay" workers because fringe benefits cost them money, said Paul Fronstin, director of the Health Research & Education Program at the Employee Benefit Research Institute. If a company decides to stop providing health insurance, they are likely to pay a little more. Companies may choose to offer workers extra money that could be used to help pay for health insurance instead of providing benefits themselves.

The Congressional Budget Office also says this will allow the government to raise more money to pay for health reform because wages get taxed but money spent on workplace health benefits doesn't. Employers that drop workers from their insurance rolls also will pay penalties to the government.

Jobs would remain the most common way for Americans to get health insurance. The new projections about health care reform don't say fewer people overall will get insurance at work, just a smaller number than the budget agency previously thought. This year, 154 million people are covered by their employers and 161 million will be in 2016, the Congressional Budget Office says.

There's no guarantee things will play out that way. Economic and budget projections are constantly changing and the parts of the health care law that are supposed to expand coverage don't exist yet. Moreover, Fronstin said, economists' assumptions about companies treating benefits like pay aren't always accurate in the real world.

Reading further it becomes obvious there are many  ‘what if's’ an unspoken hope that the present economic doldrum will come to an end, and the planners have given themselves more than ‘wiggle room’ to call it a success.

Whatever it is we should not blame “Obama Care”  Much of the ideas were formulated long before he came into office.

The Patient Affordability and Protection Act is the correct term. That term seemed the most innocuous and benevolent term for major disruption and uncertainty in the health system.

Part II (later this week)

Health Insurance Exchanges, to be….or not to be. Who will do it?

 

Technorati Tags: Hhs,public health,affordable care act,aco,uninsurable,jeff young,huffington post,congressional budget office,employers