HEALTH TRAIN EXPRESS Mission: To promulgate health education across the internet: Follow or subscribe to Health Train Express as well as Digital Health Space for all the updates for health policy, reform, public health issues. Health Train Express is published several times a week.Subscribe and receive an email alert each time it is published. Health Train Express has been published since 2006.
Wednesday, May 14, 2014
Health Train Express on the Bullet Train for Health Reform and HIT News
Some of you may have already noticed the evolution and change on the Health Train Express Blog. The publication is changing to a new format, with less opinion, and hopefully more fact.
A daily digest of trends and important breaking news in Health Reform and Health IT will be published. Our goal is to provide a wide range of subjects with appropriate links to our sources. This will allow us to continue to be a source for ever increasing news and advances, and controversy surrounding the rapid evolution of our health system.
I hope you will find the new format an efficient way of reviewing the daily activity. From time to time I will inject my own op-eds, clearly identified.
All digest sources will be clearly identified with the appropriate attribution. One person cannot do it all.
The new format and goal is to provide a high density quick review of events and trends in HIT and Health Reform
I hope our growing readership will continue to follow us by RSS feed, subscription and our networked feeds from Twitter, Facebook and Google + .
Health Train Digest for 05/14/2014 Vol 1 #1
In a detailed letter sent to both CMS Administrator Marilyn B. Tavenner and National Coordinator Karen B. DeSalvo, MD, the American Medical Association has put forth a long list of ideas to make meaningful use work better for physicians
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Despite many physicians and hospitals now meaningfully using electronic health records, there's still a huge gap when it comes to these providers actually exchanging patient data. That reality has some regional extension centers taking up the work of health information exchange. The funding, however, is often hard to come by.
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The face of telehealth is changing in ways that are becoming unrecognizable from just a few short years ago. No longer is it just a rudimentary communication between healthcare providers and patients. It is now a substantive encounter that reflects the intimacy and personal nature of a face-to-face visit, providers of new-generation technology say.
Melissa Young, MD
While the affect of the reform law isn't big for me, I'm seeing patients more aware — and not necessarily happy — about the cost associated with their care. In the process of analyzing choices for Obamacare on Health Benefit Exchanges, many uninsured and some already insured learned about deductibles, copays, provider networks and plan benefits
Martin Merritt
In medical practice, a cottage industry has developed, which is dedicated solely to legal "fault finding" without regard to equity.
The CMS canceled its first round of end-to-end testing for ICD-10 in the wake of a one-year reset of the compliance deadline, but that's not what industry experts and advocates want to hear. (MODERN HEALTHCARE)
Henry Ford Health System is being reviewed for a credit rating downgrade because of a drop in its financial performance and a pending merger that's heating up competition in the Detroit market.(MODERN HEALTHCARE)
For Michigan this is equivalent to having the Mayo Clinic losing it’s high credit rating. In 1968, while I was an intern HFH was the shining star of Detroit Michigan and the surrounding area, perhaps equal to or even exceeding the University of Michigan in Ann Arbor, just 30 minutes away. GM, Chrysler and Ford Executives and employees saw HFH as the destination of choice for advanced care, including heart surgery, kidney transplants, and also offered a wide range of research scientists in house. This headline emphasizes how sick our health system has become. HFH was modelled after the Mayo Clinic and was originally staffed by many from Harvard, John Hopkins University and other institutions known for training outstanding clinicians as well as researchers.
Chinese e-commerce powerhouse Alibaba Group has demonstrated serious interest in the healthcare information technology space, becoming the largest shareholder in a Hong Kong-based company that's building a big data platform.
Despite HHS Secretary nominee Sylvia M. Burwell getting asked some hard-line questions from several Republican lawmakers at a Senate committee hearing May 8, she did appear to receive an overwhelming bipartisan support
ObamaCare's Cascade Of Taxes Pounds U.S. Taxpayers
Grace-Marie Turner and Tyler Hartsfield
Investor's Business Daily, May 5, 2014
Sebelius out, Burwell in. The names may change, the problems remain the same. Administrators do not make policy...Congress and the President do that.
Despite HHS Secretary nominee Sylvia M. Burwell getting asked some hard-line questions from several Republican lawmakers at a Senate committee hearing May 8, she did appear to receive an overwhelming bipartisan support
The Health Train Express Digest is a condensed high density news source for health reform and health information technology. Together they form a symbiotic relationship to transform health care.
Friday, May 9, 2014
Health IT Potpouri
There is an overwhelming amount of information about HIT on the web, blogs, email newsletters and a Google search will turn up literally hundreds of resources.
For this week, May 8 2014 I have compiled this list of hot topics and links:
For this week, May 8 2014 I have compiled this list of hot topics and links:
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ROI -- whether the "I" stands for innovation or for investment -- will be among the many topics up for discussion at the National Healthcare Innovation Summit, which kicks off May 13 in Boston. The organizers promise "the kinds of innovations that people can take home and use tomorrow."
Among the healthcare developers workshopping better approaches to technology design at HxRefactored in Brooklyn next week will be Stephen Buck, who'll offer some "lessons learned" from looking closely at leading EHRs -- specifically, how not to design a user interface.
More than 370,000 Medicare and Medicaid eligible providers have earned an EHR incentive payment so far, with 64,000 new participants attesting to meaningful use for the 2013 reporting year.
The Defense Health Agency has put a foot forward with revamping its clinical information systems after it inked a bridged contract with a Reston, Va.-based technology and defense company.
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The current landscape of data exchange networks is disjointed, with health care systems scrambling to uncover sustainable business models. The need for interoperability is greater than ever. What will the model look like in the future and what are organizations doing to move toward more valuable data exchange? Ashish Shah, Medicity’s CTO, and I recently discussed these industry drivers with Anthony Brino, editor of Government Health IT. Read the article HIE at a Crossroads.
Carolinas HealthCare System CareConnect got an early start on creating a robust network for data exchange. Take a look at this recent case study highlighting Medicity’s role in connecting the health care ecosystem to enable a 360-degree view of patients across the care continuum.
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Posted: 06 May 2014 10:06 PM PDT
A while back — three months, to be exact — I asked readers if they had a preferred term to describe “the application of new, personalized technologies to healthcare.” I gave you the choice of digital health, connected health, wireless … Continue reading →
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HIE among U.S. non-federal acute care hospitals has been trending upward since 2008, in fact, and it took some major leaps forward in 2013.
Posted: 05 May 2014 09:01 AM PDT
Understanding that physicians require more comprehensive, flexible clinical documentation solutions that reflect the fast-paced highly mobile health care environment, M*Modal today announced enhancements to its Fluency Flex™ Mobile dictation application for iOS 6.0+ devices. Moving beyond the capture of clinical notes during … Continue reading →
More than half of people with chronic conditions say the ability to get their electronic medical records online outweighs the potential privacy risks, according to a new survey by Accenture.
New guidelines issued by the Federation of State Medical Boards could have a chilling effect on the growth of telemedicine -- especially in rural areas and among low-income patients, say some patient advocates, healthcare providers and healthcare companies.
Some analysts are predicting the next "great wave" in EHR purchasing among U.S. hospitals to be just around the corner. But do the numbers really bear that out?
The hits keep on coming for the new EHR certification criteria, as the American Medical Association and Telecommunications Industry Association send their complaints to ONC on the heels of similar criticism submitted earlier by the EHR Association.
The “unconfirmed rumor of a huge acquisition” that HIStalk (a.k.a. the National Inquirer of health IT) tweeted about on Wednesday apparently is that IBM was going to acquire Epic Systems. Mr. HIStalk on Thursday expressed some reservations. @DaLAWon Much … Continue reading →
The hits keep on coming for the new EHR certification criteria, as the American Medical Association and Telecommunications Industry Association send their complaints to ONC on the heels of similar criticism submitted earlier by the EHR Association.
Posted: 01 May 2014 10:51 AM PDT
Nextgov has a great article up which outlines many of the details of the soon to be bid out Healthcare Management Systems Modernization contract. I’d prefer to call it the DoD EHR Contract or AHLTA replacement contract. Certainly there’s more … Continue reading →
Explore Medical Practice Insider's guide to emerging apps and devices for the medical practic
If you want to learn more about ACO formation and Operational Issues: Attend
this event either in person, or as a webinar.
Press Release: Brookings/Dartmouth Fifth ACO Summit Announces New Keynote Speakers Sean Cavanaugh & Alice Rivlin
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For Summit registration information, visit www.ACOSummit.com/registration.php, email registration@hcconferences.com, or call 800-503-3597.
Wednesday, May 7, 2014
ObamaCare and the Tax Man Cometh
Not only did President Obama promise that “If you like your doctor, and like your insurance plan, you can keep it’ there was another promise that , “middle income families would not see their taxes go up one single dime as a result of ObamaCare”.
source
Investor’s Business Daily May 5, 2014 (Grace Marie Turner and Tyler Hartsfield)
But millions of such Americans are indeed paying to finance the gargantuan health overhaul law through hidden taxes and fees, many of which already are driving up the cost of their medical care and health insurance.
In total, the 21 taxes in ObamaCare will extract $1 trillion over a decade, nearly double the $569 billion that Congress' Joint Committee on Taxation estimated at the time the law passed in 2010.
During the next several years,
The first wave hits many higher-income people who got a rude awakening about the health law's new and higher taxes when they filed their tax forms this year.
First, is a new surtax on investment income that went into effect in January 2013. This new, 3.8% surtax is paid by households making at least $250,000 (or $200,000, single) with investment income.
In addition, households in these same income categories face an increase in their Medicare payroll taxes of 0.9%, raising their tax rate to 2.35% from 1.45% to help finance ObamaCare's subsidies. These two taxes together are estimated to cost taxpayers an additional $317 billion over the decade.
Parents of children with special needs face an added ObamaCare tax. The law caps at $2,500 a year the amount of income that employees can put tax free into their Flexible Spending Accounts. Thousands of families with special-needs children who have large medical and educational costs now must pay expenses above the cap with after-tax dollars.
People with high medical bills also face a new limit on what they can deduct for medical expenses — a threshold of 10% of their adjusted gross income instead of the old 7.5% trigger. Together, these taxes will raise about $43 billion over 10 years. (Does that make sense to tax people who have higher medical expenses to penalize them for having better coverage?)
ObamaCare also imposes a new sales tax on health insurance companies that already is increasing health insurance premiums. The tax is assessed on insurers based upon the premiums the companies collected in the previous year.
The tax will raise $8 billion in 2014, increasing to $14.3 billion in 2018, and rising thereafter based on premium trend. The Joint Committee on Taxation estimates the health insurance tax will exceed $100 billion over the next 10 years, virtually all of which will be passed along to consumers in the form of higher premiums.
The tax will increase premiums for consumers in the individual insurance market by an average of $2,150 and $5,080 for family coverage over 10 years. The average expected increase in the cost of Medicare Advantage coverage is $3,590 over the decade. ObamaCare calls for a "transitional reinsurance tax" that amounts to a $63-a-year fee on every person with private health insurance to cushion the cost of covering people with pre-existing conditions in the exchanges. The assessment is supposed to be levied for three years starting in 2014 and is designed to raise $25 billion.
An early ObamaCare tax is already hitting innovator drug companies, collecting $34 billion from the pharmaceutical industry over 10 years — passed along to consumers in higher prices and, more often, reduced investment in research for new medicines.
A tax on medical device manufacturers took effect last year, siphoning another $29 billion from creators of surgical instruments, artificial joints and even routine medical devices. The 2.3% excise tax is imposed on revenues and must be paid by companies whether or not they have any profit. Many companies say this tax is reducing significantly their investment in research for the next generation of medical devices.
It may come as a shock to middle-income Americans that the majority of these taxes hit them either directly or through higher prices they have to pay for health insurance and medical care to finance ObamaCare.”
Author (Gary M Levin M.D.)
The political ramifications of these new taxes will be apparent during the mid-term election, spotlighting the new taxes and stimulating dialogue amongst the electorate. Following this election the pump will have been primed and the next 18 months will tell if the law is repealed or amended by the next Congress and President.
Saturday, May 3, 2014
PAY 4 PERFORMANCE WHOSE?
P4P is a term that has been around for several years and is being adopted throughout the health care industry for providers and hospitals. Accountable Care Organizations are meant to provide the tools for improving outcomes, and reducing cost of health care.
CMS has already discovered that performance and cost vary greatly across the United States. The range of cost for hospitalizations varies from McAllen, Tx to Omaha Nebraska, two extremes in the analysis.
A newly recognized phenomenon will take place as the newly insured enter the risk pools and effect costs and outcomes. Cost will be driven upward, and statistical figures for outcomes will decrease, because of more severe illness, and lack of compliance by new patients. Health illiteracy amongst the newly insured and will be a category with whomt providers, hospitals and insurers will be challenged. This will drive care costs upward unless dealt with during their initial contacts with providers. Fortunately technology has advances so that webinars, tutorials, and even video conferenceing will aid in this process at little cost. Bilingual souces are critical since many patient will be ESL of Spanish speaking only..
- Those entering the market will be sicker and have more chronic disease. They are less informed about prevention and health diets.
- Their outcomes, length of hospitalizations, and readmission rates will also reflect the lack of compliance, lack of understanding of health care process, and lack of socioeconomic power to chose wisely.
- Many ACA provisions look to boost care by linking Medicare payments to the performance of doctors, hospitals and health plans. Doctors and hospitals that treat “poorer people” are more likely to face financial penalties, which will diminish resources providers need to administer and improve care.
Healthcare experts say the payment system must evolve and adapt to the changing market so that payments and volume based reimbursement can change to value-based benefits.
In a recent study, sixty-five percent of 170 C-level payer executives said they will launch pay for performance programs over the next three years (this according to Fierce Health Players in a Health Edge Survey released last fall (2013)
The only item left out is patient accountability. Patient performance can be measured in many ways, incentives and penalties can also be implemented on the demand side of analysis and outcomes. If a patient is non-compliant, does not keep appointments and fails to follow discharge instructions, providers and hospitals must not be penalized for patient failure.
Poor outcomes may not be due to physician non compliance, and they should not be punished because a patient fails to get well, or not comply. Providers and hospitals cannot be expected to bear the entire burden of patient disease…..some diseases mayn be ameliorated, but not cured.
Outcome and treatment paradigms evole with time and the P4P analysis must be fine tuned for these inevitable changes.
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