Thursday, April 29, 2010

Health Information Technology: Creating Jobs, Reducing Costs and Improving Quality Conference

Dr. John Halamka wrote on The Healthcare Blog about the conference "Health Information Technology: Creating Jobs, Reducing Costs and Improving Quality Conference" hosted by Massachusetts Governor Deval Patrick. Thursday, April 29, 2010 there were remarks from HHS Secretary Kathleen Sebelius and a keynote address from David Blumenthal, MD the National Coordinator for Health Information Technology. On Friday's session at 9:30 am Eastern Time is the panel below:

Getting Clarity - Developing Effective Health IT Policies and Standards

  •  John Halamka, MD, CIo, CareGroup and Harvard Medical School
  •  J. Marc Overhage, MD, Ph.D, CEO, Indiana Health Information Exchange
  •  Paul Tang, MD, CMIO, Palo Alto Medical Foundation
  •  Micky Tripathi, Ph.D, President and CEO, Massachusetts eHealth Collaborative
  •  Moderator: Tim O'Reilly

Apparently the Livestream is not working this morning... :-(

Maybe it will be recorded in the library here:

Wednesday, April 28, 2010

Vish moves on...

The following letter is the announcement by Vish Sankaran, program director for HHS's Office of the National Coordinator for Health Information Technology Federal Health Architecture initiative, that he is leaving the agency. He has been an inspirational and transformational figure in health IT and I wish him well in this next chapter in his life.
Within the next several weeks I will be departing from the Federal Health Architecture program to seek other opportunities.
This was not an easy decision, but it comes at an ideal time for FHA and for me, when FHA is reshaping to fit in with the overarching federal health IT body being formed.
This is also a great time to bring in new leadership to further the great work you’ve already accomplished. And on the personal front, I am exploring exciting new opportunities that will allow me to continue my passion.
My departure has allowed me to look back and review FHA’s legacy – a legacy built through all of our hard work. I joined the Office of the National Coordinator for Health IT shortly after our nation’s leadership issued Presidential Executive Order 13335, which set up the ONC and called for a commitment to build a nationwide electronic health information system.
When agencies were called upon to work together to enable interoperability and improve services to their beneficiaries, the agencies responded! Twenty federal agencies came together to discuss more than challenges – they joined workgroups dedicated to determining common needs, worked together to develop tools and solutions, and most importantly, they shared their experiences in advancing health IT within their own agencies and with their counterparts. We all learned and benefited from this collaboration.
Our achievements have been significant, creating a template for how the public and private sectors could work together to set a new bar for health information exchange and to create an “ecosystem” of buyers and sellers in the marketplace. A great illustration of our collaboration is the CONNECT solution, which has been adopted by both government agencies and the private sector. This open-source platform has evolved into a venue for innovation which continues to this day.
Our efforts have not gone unnoticed. FHA has been on the agenda of more than 150 conferences and meetings dedicated to health IT. Media coverage of the program can be found in a wide range of publications and online media sites. Most gratifying is that our program has received seven awards from organizations recognizing innovation in health IT.
Without your strong and steadfast support, we would not have made the mark that we did. My time here was my first exposure to the inner-workings of the federal government – and more than anything else, I learned that our government is staffed with dedicated and hard working individuals. I wish all Americans would have had the opportunity to share my experience. I now understand that public service is more than a career – it is a calling.
I look forward to continuing to be involved in the national effort to make health and human services a transformative force for our society. I know that I will have the opportunity to see many of you again. Until I do, I trust you know that you have my thanks and appreciation for all you have done during my tenure as FHA Program Director. Let us keep advancing the “openness” in our government activities and work across the public and private sector to reduce cost and improve health and human services to our citizens.
Friends, the “Patient is Waiting”!
Take care,
Vish Sankaran
Program Director
Federal Health Architecture
Office of the National Coordinator for HIT

Tuesday, April 27, 2010

Songbird's Genome

The Australian zebra finch, Taeniopygia guttata, weighs less than half an ounce, mates for life and, unlike most vocalizing animals, learns its songs from its elders. A new analysis of its genome, the first of a songbird, is providing clues to the mechanisms and evolution of vocal communication. Nearly all animals make sounds instinctively, but baby songbirds learn to sing in virtually the same way human infants learn to speak: by imitating a parent.

Researchers at Washington University in St. Louis, the University of Illinois at Urbana-Champaign, Uppsala University, UCLA and more than 20 other institutions collaborated on the analysis, which appears here in the journal Nature.

“Now we can look deep into the genome, not just at the genes involved in vocal learning, but at the complex ways in which they are regulated,” says senior author Dr. Richard Wilson, The Genome Center’s Director. “There are layers and layers of complexity that we’re just beginning to see. This information provides clues to how vocal learning occurs at the most basic molecular level in birds and in people.”

Because zebra finches learn to sing in a predictable way and many of their genes are conserved in humans, they are an important model for understanding vocal learning in humans. Many of the same genes involved in the bird’s ability to learn songs are also involved in human language learning. The work also sets the stage for future studies that could help identify the genetic and molecular origins of speech disorders, such as those related to autism, stroke, stuttering and Parkinson’s disease.

Monday, April 26, 2010

Aging in Place: The National Broadband Plan and Bringing Healthcare Technology Home

The Senate Committee on Aging held a hearing "Aging in Place: The National Broadband Plan and Bringing Health Care Technology Home" focused on the spread of broadband and how health IT could improve the relationships and communication between patients and their doctors. The panel offered a preview of the government’s future role in healthcare, showing how Americans may interact with doctors and other healthcare providers using the latest technology. The panel statements and video of the hearing are below. There was a broad bipartisan consensus the information technology can help improve clinical outcomes and lower costs.

“The development of the broadband network and health information technologies has the potential to truly transform health care and simultaneously enable better outcomes and lowering costs,” said Sen. Susan Collins (R-Maine).

“Five percent of Medicare beneficiaries, who in most cases have one or more chronic conditions, constitute 43 percent of Medicare spending,” said Dr. Mohit Kaushal, Digital Healthcare Director, at the Federal Communications Commission. He was testifying before the committee via video conference due travel disruptions caused by the Icelandic volcano. Speaking about recent economic studies (see citations in testimony below) he said "Although economic studies like these are open to criticism due to the difficulty in quantifying savings," Kaushal said, "the Veterans Hospital System has implemented its Care Coordination / Home Telehealth Program for 32,000 veteran patients with chronic conditions. The program has resulted in a 19 percent reduction in hospital admissions and a 25 percent reduction in bed days for those veterans who are admitted."

There were some interesting demonstrations of technology that may help move us in this direction. One interesting device shown was an automatic drug dispenser that can monitor and adjust medication dosages wirelessly, allowing doctors to tailor dosages of drugs such as insulin without having to schedule visits with patients in their office. “What we’re talking about, folks, is using a device like this one,” Sen. Ron Wyden (D-Ore.) said, as he showed the device. “It attaches to the patient’s skin and is loaded with drugs that are administered in the exact way that the doctor prescribes – wirelessly.

“That means that a doctor can vary the doses based on the information the doctor is receiving. The patient doesn’t have to go in to the doctor and then the pharmacy to change his or her prescription,” he said. “This device here connects to other devices that measure a patient’s blood pressure and glucose levels – things that any doctor treating a diabetic patient wants to know about,” Wyden said. “It wirelessly uploads this data to an electronic medical health record that is monitored by a health care professional.”

Another interesting discussion was around wireless monitoring of nutritional information, and sensors worn on the body or placed around the home that can detect if an elderly person has experienced a fall, alerting emergency personnel and the person’s doctor. Professor of pathology and associate director of clinical chemistry at The University of Virginia School of Medicine Robin Felder told the committee, "Continuous monitoring of vibrations in the floor can detect falls and classify them according to the best choice of first responders – either a 911 call or a visit from a caregiver."

"Emerging technologies allow pills to be electronically outfitted with transmitters to communicate with the user’s wristwatch that shows that the pill has been consumed,” claimed Felder. “Broadband connectivity of these devices would allow the electronic medical record to be updated with regard to medication compliance and efficacy."

Eric Dishman, global director of health innovation and policy at Intel Corporation, compared the new paradigm of health 2.0 to the e-mail revolution of the late 1990’s, saying that new health technology is not meant to replace the doctor-patient relationship but to enhance it using new tools. “None of this effort is about replacing the traditional doctor-patient relationship, but it’s about enhancing and extending it to more people and regions of the country,” Dishman explained.

“Just as e-mail became a new way of interacting with other people that didn’t replace all other forms of communication such as phone calls and letters, e-Care uses new technologies to create a new way of providing care that complements – but doesn’t replace – all clinic visits,” he said.

The recent health reform legislation included the new Center for Medicare and Medicaid Innovation. The center is charged with testing innovative payment and service-delivery models designed to reduce Medicare and Medicaid expenditures while preserving or enhancing the quality of care. The center will be running pilot projects and the legislation gave the HHS Secretary authority to expand pilots that she determines would reduce spending or improve the quality of care.

“The new Center for Medicare and Medicaid Innovation is given authority to test innovative payment and service model,” said Dr. Farzad Mostashari, senior advisor at the Office of the National Coordinator for Health IT at the Department of Health and Human Services while testifying before the committee. "Delivery of critical healthcare services in patients' communities and homes can reduce costs borne by patients, providers and health insurers and increase patient satisfaction," he said.

“These models may include care coordination for chronically ill individuals at risk of hospitalization through telehealth, remote patient monitoring, care management, and patient registries,” he explained.

There is little doubt that new technology solutions offer great promise to improve quality of care while reducing health care costs. There are many efforts working towards achieving this shared vision. Hopefully we can continue to put partisan differences aside as these different projects work in concert to move healthcare into the future.

Panel Statements:

  • Mohit Kaushal, Digital Healthcare Director, Federal Communications Commission, Washington, DC
  • Farzad Mostashari, Senior Advisor to the National Coordinator for Health Information Technology, US Department of Health and Human Services, Washington, DC
  • Eric Dishman, Intel Fellow, Intel Corporation, Global Director of Health Innnovation and Policy, Intel Digital Health Group, Senior Policy Adavisor, Continua Health Alliance, Senior Fellow, Center for Aging Services Technologies, Washington, DC
  • Robin Felder, Professor of Pathology, Associate Director Clinical Chemistry, The University of Virginia School of Medicine, Charlottesville, VA
  • Richard Kuebler, Telehealth Department Head, University of Tennessee Health Science Center, Memphis, TN

Sunday, April 25, 2010

Remote Area Medical Los Angeles

Remote Area Medical (RAM) is conducting its 601st free clinic and its second in Los Angeles. I wrote about their first successful effort in LA last year, and this year will be bigger than ever. In fact, it could be the largest event of its kind ever. RAM/LA will bring medical, dental and vision care to thousands of individuals and families who desperately need it, absolutely free. No proof of insurance, no income test, no requirement of any kind, except to attend.

RAM/LA is a community effort. Medical and non-medical personnel are volunteering their time; supplies and equipment are being donated; local agencies and organizations are generously providing their resources. Be sure to Follow their work this week on Twitter at @RAMLosAngeles and if there is any way you can assist by donating time, money, resources, or even just spreading the word about this important work please help where you can.

Los Angeles ABC Channel 7 has provided some good coverage of the beginning of the clinic's work this year in Los Angeles:

Remote Area Medical has been featured in the national media a number of times in recent years. Below is a feature from CBS's 60 Minutes showcasing the work the volunteers provide to patients whose health needs are greater than they can afford.

Friday, April 23, 2010

It's Cherry Mania Time!

Each year the City of The Dalles celebrates the Cherry Festival honoring the coming of the cherry blossoms and looking forward to the upcoming harvest. This is now the 31st year of the annual celebration and it looks like the weather is going to cooperate for a great weekend. Our local Chamber of Commerce has a nice overview of the weeks events, but the parade on Saturday and the three-day four stage bicycle race by the Oregon Cycling Association are pretty big deals.

Agriculture provides a solid economic base in the cherry-growing haven around The Dalles and is a big part of life around here. The major agricultural product of the City is sweet cherries and The Dalles is a producer for both domestic and overseas markets. There are in excess of more than 10,000 acres acres of sweet cherry trees surrounding the City yielding about 25,000 tons a year. Every spring, cherry blossoms blanket the orchards dotting the Columbia River Gorge providing a beautiful backdrop for cycling, hiking and other outdoor activities. What began with 700 fruit tree rootings brought to the area by covered wagon in 1847 has matured through generations of dedicated families.

The Cherry Festival is a lot of fun and brings the entire community together. I always love a parade and I look forward to spending a lot of time with family and friends this weekend. The city has hundreds of bicyclists from all over for the Cherry Blossom Classic and there will be some rip roaring parties as well.

Rooftop65 has a pretty neat slideshow on Flicker but you really have to be here to fully experience it:

HHS Semiannual Regulatory Agenda

Monday, April 26, 2010 the Health and Human Services Department will publish their Semiannual Regulatory Agenda in the Federal Register. To items of note that are scheduled for final action in May:

  • Modifications to the HIPAA Privacy, Security, and Enforcement Rules Under the Health Information Technology for Economic and Clinical Health Act
  • Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology (Rulemaking Resulting From a Section 610 Review)

The cost of reform

Beginning in 2014, the Patient Protection and Affordable Care Act, in combination with the Health Care and the Education Reconciliation Act of 2010, requires most residents of the United States to obtain health insurance and imposes a financial penalty for being uninsured. That penalty will be the greater of a flat dollar amount per person that rises to $695 in 2016 and is indexed by inflation thereafter (the penalty for children will be half that amount and an overall cap will apply to family payments) or a percentage of the household’s income that rises to 2.5 percent for 2016 and subsequent years.

About 21 million Americans will still be uninsured in 2016, when health care reform laws are fully implemented, with 4 million of them subject to a penalty for failing to buy insurance. It is not just the well off that will be paying penalties under the new health reform legislation. Penalties will be enforced against approximately 360,000 families who have annual income below the poverty line: $11,800 for individuals and $24,000 for a family of four. Fees paid by poor people will be $160,000,000.00 or about 4% of the total money collected from penalties.

The Congressional Budget Office (CBO) and the staff of the Joint Committee on Taxation (JCT) have estimated that about 21 million nonelderly residents will be uninsured in 2016, but the majority of them will not be subject to the penalty. Unauthorized immigrants, for example, are exempted from the mandate to obtain health insurance. Others will be subject to the mandate but exempted from the penalty—for example, because they will have income low enough that they are not required to file an income tax return, because they are members of Indian tribes, or because the premium they would have to pay would exceed a specified share of their income (initially 8 percent in 2014 and indexed over time). Individuals may also be granted waivers from the penalty because of hardship and may be exempted from the mandate on the basis of their religious beliefs.

Among those who are subject to the penalty, many will voluntarily report on their tax returns that they are uninsured and pay the amount owed. However, other individuals will try to avoid making payments. Therefore, the estimates presented here account for likely compliance rates, as well as the ability of the Internal Revenue Service (IRS) to administer and collect the penalty. In total, about 4 million people are projected to pay a penalty because they will be uninsured in 2016 (a figure that includes uninsured dependents who have the penalty paid on their behalf).

CBO and JCT estimate that total collections from those penalties will be about $4 billion per year over the 2017–2019 period. The table below shows the distribution of payments that are projected to be made for being uninsured in 2016 (which the IRS will actually collect in 2017) by income measured as a percentage of the federal poverty level (FPL). In general, households with lower income will pay the flat dollar penalty, and households with higher income will pay a percentage of their income. In 2016, households with income that exceeds 400 percent of the FPL are estimated to constitute about one-third of people paying penalties and to account for about two-thirds of the receipts from those penalties

Wednesday, April 21, 2010

SHARP Focus: Center for Health Information Privacy and Security

SHARP Security

The Strategic Healthcare IT Advanced Research Projects on Security (SHARPS) project is a multi-institutional and multidisciplinary research project, supported by a grant from the Office of the National Coordinator, aimed at reducing security and privacy barriers to the meaningful use of health information technology. The grant is one of the four awarded through the Strategic Health IT Advanced Research Projects (SHARP) program to address key challenges in adoption and meaningful use of health IT. I wrote previously about the University of Texas Health Science Center at Houston research which will focus on Patient-Centered Cognitive Support, and the Harvard research program on new health care application and network-platform architectures. Now we will look at the SHARPS research project on security of health IT.

The SHARPS project will advance the sophistication, development, and deployment of security and privacy for health IT through research that is strategically managed for fundamental impact with some incremental short-term benefits. The Center for Health Information Privacy and Security has been established under the direction of Carl A. Gunter (see interview below). The Center houses the multi-institutional and multidisciplinary SHARPS research project. For continuing updates on the Center's work visit the SHARPS project web site. SHARPS is organized around three major environments:
  • Electronic Health Records (EHRs) 
  • Health Information Exchanges (HIEs) ~ with Personal Health Records (PHRs) included as a major subtopic
  • Telemedicine (TEL)
The EHR project focuses on issues related to the security and privacy of health records within a single enterprise, such as a hospital or doctor's office. The EHR project includes three components:
  1. Self-Protecting EHRs addresses defense-in-depth protection of records within an enterprise or in outsourcing by using attribute-based encryption to enforce SHARPS-developed protection requirements
  2. Policy Terrain and Implications of HIT addresses the inadequacy of existing frameworks for formulating and understanding privacy policies by developing contextual integrity underpinnings for application-enabling privacy practices
  3. Privacy-Aware Health Information Systems meets needs for highly assured conformance to privacy policies by developing new strategies for building such systems based on trust management systems
The HIE project is concerned with security and privacy of health records that are exchanged between enterprises or individuals or held by individuals (PHRs). The HIE project has three components:
  1. Responsive, Secure Health Information Exchange addresses the inadequacy of current service models for exchanges by demonstrating how model-based design can be applied to HIT
  2. Experience-Based Access Management addresses the need for an engineering model for the evolution of access controls limiting insider threats with a lifecycle model based on strategies from attribute-based rule sets and machine learning
  3. Personal Health Records addresses the inadequacy of privacy standards for third-party PHRs through policy exploration with PHR stakeholders, leading to development and transition of supporting technology
The TEL project addresses security and privacy in the control of implants, remote monitoring, multimedia communications, and medical device risk assessment. The TEL project has four components:
  1. Implantable Medical Devices addresses control operations on implanted medical devices without proper authorization by developing techniques for achieving measurable security for such devices relative to specified infrastructure
  2. Remote Monitoring for Mobile and Assisted Living addresses usable security for remote monitoring and home healthcare with an mHealth security framework and service model
  3. Tele-immersion addresses the need for efficient provisioning for security and privacy in tele-immersion by linking classification to encryption
  4. Patient Safety Assessment addresses inadequate quantification of safety risks for medical devices in the face of security threats with a plan based on using Food and Drug Administration (FDA) adverse event reports to develop risk assessments
Each project will be staffed by a multi-institutional, interdisciplinary team consisting of researchers at universities in collaboration with industrial partners, consultants, and advisors. These teams provide coordination among researchers with the highest level of expertise in security and privacy for HIT. The universities involved are Carnegie Mellon University, Dartmouth College, Harvard University, Johns Hopkins University, New York University, Northwestern University, Stanford University, the University of California at Berkeley, the University of Illinois at Urbana-Champaign, the University of Massachusetts at Amherst, the University of Washington, and Vanderbilt University. Principals from these universities are grouped into teams that associate PhD security and privacy computer science researchers with MD researchers and high-level information officers in healthcare organizations. These teams are supported by industrial partners and consultants. The overall project is advised by a distinguished project advisory committee that draws on leaders in academic research, industrial research, healthcare delivery organizations, developers of HIT, government healthcare, policy leaders, and stakeholder groups. The project organization assures project synergy and the capacity to act as an effective collaborator with a Federal Steering Committee at Health and Human Services.

The first anticipated outcome of the project is to improve the maturity of security and privacy technologies and policies to remove a key range of security and privacy barriers that prevent current HIT systems from moving to higher HIT Meaningful Use Stages. The second anticipated outcome of the project will be the creation of an integrated multidisciplinary research community in security and privacy for HIT that will carry progress forward beyond the scope and duration of the SHARPS project.

I spoke with Carl today and he gave a great overview of the project and shared some of his insights as to how this research project will move forward. The audio of the conversation is below:


Tuesday, April 20, 2010

Preserving Tweets

The Library of Congress (LOC) announced (on Twitter) that they will begin archiving all public tweets, from when Twitter first started March 21, 2006. Twitter announced the preservation of tweets as well while also mentioning the new Google Replay, which will eventually allow searching back to the very first tweet.

Matt Raymond, Communication Director of The National Archives, talked with CSPAN about Twitter's donation of its entire digital archive of public tweets to the Library of Congress. Highlights of the donated material include the first-ever tweet from Twitter co-founder Jack Dorsey and President Obama's tweet after he won the Presidency.

The LOC is the appropriate place for this, although the National Archives will probably also house all "official" government tweets. As David Ferriero, Archivist of the United States, said in his blog posting:
You might wonder why the National Archives did not acquire the tweets. Our primary purpose is to acquire, preserve, and make available for research the most valuable records of the Federal Government. Because tweets aren’t government records (although tweets of federal agencies can be), the Twitter archive is much better served by the Library of Congress as a cultural institution. At the National Archives, we are working with over 250 Federal agencies and their components to identify and schedule Federal records, some of these most certainly are tweets. Our records appraisal process identifies those records that are valuable enough to be permanently preserved.

Sunday, April 18, 2010

SHARP Focus: Indivo Personally Controlled Health Record

Researchers at Children’s Hospital Boston and Harvard Medical School will lead the efforts of a $15 million grant from the Office of the National Coordinator for Health Information Technology to support research and development of a new health information technology infrastructure. The grant is one of the four awarded through the Strategic Health IT Advanced Research Projects (SHARP) program to address key challenges in adoption and meaningful use of health IT. I wrote previously about the University of Texas Health Science Center at Houston research which will focus on Patient-Centered Cognitive Support. Now we will take a look at the Harvard program on new health care application and network-platform architectures.

This four-year project will be led by Isaac Kohane, MD, PhD, and Kenneth Mandl, MD, MPH, of the Children’s Hospital Informatics Program and Harvard Medical School, and will investigate, evaluate, and prototype approaches to achieving an “iPhone-like” health information technology platform model, as was first described by Mandl and Kohane in a March 2009 Perspectives article in The New England Journal of Medicine.

The platform architecture, described as a “SMArt” (Substitutable Medical Applications, reusable technologies) architecture, will provide core services and support extensively networked data from across the health system, as well as facilitate substitutable applications – enabling the equivalent of the iTunes App Store for health. This will stand in stark contrast to the way health information systems have been designed and implemented to date, and will encourage evolution, competition, innovation and efficiency in health care and technology.

The SMArt platform will provide a common interface to the “App Store” for the Indivo open source personally controlled health record platform developed by the CHIP team more than a decade ago and is the codebase behind Dossia. The work will also include open source platforms created by other subcontractors on the ONC grant: Partners HealthCare System’s i2b2 analytic platform and the Regenstrief Institute’s CareWeb EHR.

This is going to be very important because there will be certification of EHR modules, but as yet there is no data exchange and workflow integration between modules. So hopefully this research will provide some solutions for this difficulty. Also there will eventually be a common platform upon which most personal health applications will need to be built. The dominant platform may eventually be Microsoft HealthVault, Google Health, or perhaps something from the Mirth, NHIN Direct or CONNECT projects. But the Indivo X project appears to me to be an important component of the future of the health Internet.

some material provided by

Saturday, April 17, 2010

Why I do this...

On December 19, 2008 I joined Twitter, although I only tweeted a few times over the first couple months. One year ago on April 17, 2009 I decided to start writing a blog and actually using Twitter. My first blog post simply pointed to my Twitter feed and I was off and running. I tried to find my first tweet, but haven't been able to scrounge it up yet. Since I have over 12,000 tweets none of the services like or work for me (there is a 3200 tweet limit), eventually Google's new timeline search will allow me to go back as far as the very first tweet on March 21, 2006. In the meantime, searching back through my tweets archived on FriendFeed I was able to find this early tweet of mine, but I know that I have earlier ones.

So over the last year I have tweeted over 12,345 times (and counting) and this is the 356th post on the blog. That is about a post a day, excluding some holidays, and about 33 tweets a day. I have spent quite a bit of time reading , discussing, researching and sharing information over this past year. So why have I taken so much time and effort to publish all of this on the Internet?

Well, I care very deeply about healthcare in our country and am passionate about improving our government using technology. Really, this has become quite a hobby of mine. Some of my friends like to fly fish or go windsurfing, some like to fly airplanes go sailing, I like to tweet and blog. It has actually been quite fun and since I only sleep a few hours a night, not all that difficult for me to stay engaged. I seem to have a knack for finding information that people find useful and I enjoy disseminating it to anyone that might share my interests.

Fortunately my job has been able to mesh well with many of my interests so that research and reading that I do for work can then be shared with my readers. It is a blessing to be able to work in an area that I am passionate about. Since I was elected to City Council in 2008, I have become increasingly interested in finding ways to use technology apply open government principles. Attending the Gov 2.0 Summit last year was one of the big thrills of my life, and much of the networking leading up to the event was made possible through social media. Tweets can sometimes open doors of opportunity. I actually got to meet Andrew McLaughlin, Aneesh Chopra, and Tim O'Reilly and many other luminaries and folks I have admired from afar.

Over the past year I have tried to stay focused and keep most of my tweeting and posting meaningful and relevant to healthcare, technology and government 2.0 (with a few occasional side trips into glimpses of my personal life). Much of my more personal social networking occurs on Facebook, where I mostly stick to people who I have actually met in person. This past year has also seen the advent of Google Wave and Buzz(which has mostly replaced FriendFeed for my conversations, although FriendFeed is a great searchable archive for my tweets), Twitter added Lists and other new features, and we saw both Google and Bing begin to include tweets in their search results. This next year will see even more changes and I believe we will see increased adoption of social media tools, particularly mobile.

I have really enjoyed this past year and am very grateful for all the folks who have read my posts, the comments, tweets and retweets, and the fantastic online community I have been honored to participate in. Anyway it has been fun reminiscing this weekend over the past year and going back and reading through some of things I've been part of. This has been a wild ride and I look forward to this next year's journey. I am grateful to be able to be part of it all...

Friday, April 16, 2010

Eligible provider fix along with temporary SGR fix

The president has signed H.R. 4851 into law. The bill was approved by the Senate on a 59-38 vote and by the House on a 289-122 vote. This will provide a temporary delay on a 21% cut in Medicare physician payments until June.

There is an important section on clarification of the definition of an eligible provider (which was a serious flaw in the NPRM) being able to participate in Medicare incentive payments for achieving meaningful use. I am very please to see this language clarified so that we do not need to rely on the rule making process for this to fixed, since it is now handled legislatively. The section pertaining to eligible providers is:
(a) Qualification for Clinic-based Physicians-
(1) MEDICARE- Section 1848(o)(1)(C)(ii) of the Social Security Act (42 U.S.C. 1395w-4(o)(1)(C)(ii)) is amended by striking `setting (whether inpatient or outpatient)' and inserting `inpatient or emergency room setting'.
(2) MEDICAID- Section 1903(t)(3)(D) of the Social Security Act (42 U.S.C. 1396b(t)(3)(D)) is amended by striking `setting (whether inpatient or outpatient)' and inserting `inpatient or emergency room setting'.
(b) Effective Date- The amendments made by subsection (a) shall be effective as if included in the enactment of the HITECH Act (included in the American Recovery and Reinvestment Act of 2009 (Public Law 111-5)).
(c) Implementation- Notwithstanding any other provision of law, the Secretary of Health and Human Services may implement the amendments made by this section by program instruction or otherwise.

Wednesday, April 14, 2010

Bill Moyers Journal: Wendell Potter on the Healthcare Bill

PBS has posted the YouTube video below which has a fascinating discussion with Wendall Potter. After twenty years as a corporate public relations executive, he left his job as head of communications for one of the nation's largest health insurers to advocate for meaningful healthcare reform. Bill Moyers interview him for his show and it is well worth watching. The transcript is provided from the PBS web site.

Bill Moyers speaks with former insurance executive turned public health advocate Wendell Potter, who argues that all is not lost in the healthcare bill and details what he likes about the legislation. 

March 5, 2010
BILL MOYERS: Welcome to the Journal.
Ever since last week's White House summit, it's been like one big game of political ping pong, with the president and Democratic and Republican leaders paddling health care talking points back and forth so fast, the rest of us can hardly keep up. So for the moment, we're going to step away from that game, remove ourselves from the roar of partisan rhetoric and remind ourselves of why this country needs health care reform in the first place.
One day before that big summit last week, there was a hearing in Congress to find out why Anthem Blue Cross of California is raising premiums by as much as 39 percent -- 15 times the rate of inflation.
REP. BART STUPAK: Do you swear or affirm the testimony you're about to give to be the truth, the whole truth, and nothing but the truth in the matter pending before this committee?
BILL MOYERS: Angela Braly, the CEO of WellPoint, the parent company of Anthem Blue Cross and Blue Shield, was called before a House subcommittee to explain the increase.
REP. MICHAEL BURGESS: You know, you had to know this was going to be trouble. I mean, a 39 percent rate increase in this climate. You know what we've been doing up here the last year?
REP. MICHAEL BURGESS: You know what's happening down at the White House tomorrow?
REP. MICHAEL BURGESS: You knew this was going to be trouble.
REP. MICHAEL BURGESS: So you knew the landscape into which you were entering, correct?
REP. MICHAEL BURGESS: Did you make a judgment as to whether or not this was the best time to do this?
ANGELA BRALY: It's a difficult situation and even to break even the rates would have been in the 20s in terms of overall average, the overall average. And we were concerned which is why we also capped the rates at the top end of 39 percent because we did not want rates for individuals to go in excess of that cap.
BILL MOYERS: News of the increase was brazen and shocking enough on its own. But it turns out that in 2008 WellPoint paid 39 of its executives a million dollars or more. And that over two years alone, the company spent more than 27 million dollars for executive retreats at luxury resorts. Fresh ammunition for those who argue that health care costs wouldn't be skyrocketing if the insurance industry didn't put profit ahead of patients.
REP. BART STUPAK: It'd be great if we could guarantee every business to have 2.5 to five percent profit, and heck, you're at 7 percent or more.
ANGELA BRALY: You know, actually over the five-year period our profit margin has declined. We continue to get more efficient as a company and as a business, and we are working hard to reduce health care costs and improve access to high quality affordable health care. So it is important, to be a business that sustains, that we have an appropriate profit. And we think a 4.8 percent margin on a relative basis is very efficient.
BILL MOYERS: That's 4.8 percent of the 60-plus dollar billion in earnings WellPoint reported last year. In other words, nearly three billion dollars of profit after taxes.
REP. BART STUPAK: I don't mind you making a profit but at the end of the year 2009, a horrible year, you still made two-point-something billion dollars. And that's not enough?
ANGELA BRALY: And we serve 34 million Americans across the country and we feel that it is appropriate for our business to be sustained so that we can be there for those members when they incur those health care costs.
BILL MOYERS: Anthem Blue Cross policy holders testified that with the big jump in premiums, their only options are to pay through the nose, switch to a cheaper policy with less protection or drop their insurance completely.
JEREMY ARNOLD: I will have to hope that I don't get sick or injured. Hope is not an effective health care policy and hope is not what Anthem is supposed to be selling. I eat right, I exercise, I take care of myself, I am generally a healthy person and I resent being squeezed in this way.
JULIE HENRIKSEN: In this economically depressed environment, I find the act of Anthem Blue Cross raising premium costs to individual policy holders for such high amounts truly unconscionable. My current policy states that I must meet an annual one thousand dollar deductible for each two members of my family, which totals 3 thousand dollars and an annual out-of-pocket expense of 4,500 dollars for each two members of my family which totals nine thousand dollars, in addition to the yearly premium of 12 thousand dollars that I pay already.
REP. BETTY SUTTON: Do you believe a company that can afford to pay a single executive nearly 10 million dollars in one year has the right to demand higher premiums from you so that it can, quote, "keep up with the market?"
JULIE HENRIKSEN: It makes me sick to think that all of this money is going to executives in this economy when so many people are struggling.
JEREMY ARNOLD: I, of course, too think it's unconscionable and I believe the number I read was that in the last quarter WellPoint had a profit of over 4 billion dollars. Even if you cut that in half, it's still an incredibly healthy profit. So it just speaks to, as I said in my testimony, profiteering versus profit-making. There is a difference. And profit-making is fine. It drives our economy. It's the foundation of American business. But profiteering, when it affects people like us in the way that it has, is just wrong. It speaks to a lack of decency. And lack of decency may not be illegal but it's wrong. And that's why I think it requires government intervention and regulation.
BILL MOYERS: WellPoint's Angela Braly stayed on message. She was unapologetic about her company's profits. But what she heard back from the subcommittee was, "Shame on you."
REP. JAN SCHAKOWSKY: I think that a 39 percent rate increase at a time when people, Americans, are losing their jobs, losing their health care, is so incredibly audacious, so irresponsible. How much money do you make?
ANGELA BRALY: My salary is 1.1 million dollars. I receive stock compensation with a value of 8.5 million dollars and last year an annual incentive payment of 73 thousand dollars.
REP. JAN SCHAKOWSKY: Well, of course, it makes sense then that you would need a big rate increase.
REP. BART STUPAK: Do you think you're finally going to get to the point where basically you're killing the goose that laid the gold egg; no one's going to be able to afford you?
ANGELA BRALY: You know, it is really an issue that we have got to get to the underlying cost of care because we want access to health care. It is-- there are wonderful advances, wonderful technologies and we want to make sure that we continue to have access
ANGELA BRALY: And that our customers continue to have access. And it needs to be affordable. And so we have to think about how--
REP. BART STUPAK: But do you believe there's going to be a point when we can no longer afford it, individuals?
ANGELA BRALY: I think we as human beings greatly value our access to health care, which is why we continue--
REP. BART STUPAK: I agree and every family has to make a value judgment; can I afford it today or not. So when my rates go up 39 percent as these, our first panelist said, we look at it, and pretty soon it's going to be can I afford it any more or do I just drop it and hope I don't get sick?
ANGELA BRALY: Which is why we are in the market saying we have to get to reducing health care costs, making sure that people aren't getting unnecessary procedures or redundant procedures. We play that important role in health care. To eliminate us from the process eliminates the opportunity to get to that value equation.
REP. BART STUPAK: And you're getting to the point where no one can afford it.
ANGELA BRALY: And we are serving 34 million Americans across the country and our goal and desire is to try to get for them affordable health benefits that they can continue to access the quality care, the drugs that they need and want--
REP. BART STUPAK: And it's not working. When I came to Congress, like our first panel, small business people, 64 percent, and the people had health insurance. We'd buy it. Now, we're down to about 34 percent. That's why we have to do something on health care in this country because the cost is killing us.
BILL MOYERS: Sure enough, last year, with millions of people out of work and our economy in a tailspin, the country's five largest health insurers increased their profits by 56 percent, to over 12 billion dollars.
So if President Obama and Congress finally agree on health care reform, does it get us any closer to solving problems like this? Who really wins -- the health insurance industry or the rest of us? That's one reason why I invited Wendell Potter back to the Journal.
Our conversation with him last summer resonated far and wide because he had just gone public--
WENDELL POTTER: What we have today, Mr. Chairman, is Wall Street-run health care.
BILL MOYERS: --testifying before Congress about an industry in which he once had thrived, as head of corporate communications for Cigna, the country's fourth largest health insurance company. Wendell Potter was an insider, an industry executive who had fought long and hard against health reform, until one day in 2007 when he came upon a rural free clinic in West Virginia.
WENDELL POTTER: What I saw were doctors who were set up to provide care in animal stalls. Or they'd erected tents, to care for people. I mean, there was no privacy. In some cases -- and I've got some pictures of people being treated on gurneys, on rain-soaked pavement. And I saw people lined up, standing in line or sitting in these long, long lines, waiting to get care. It was absolutely stunning. It was like being hit by lightning. It was almost like -- what country am I in? It just didn't seem to be a possibility that I was in the United States.
BILL MOYERS: Wendell Potter returned from that experience a changed man. He quit his job at Cigna, became a Senior Fellow at the Center for Media and Democracy and ever since has been one of the country's leading champions of health care reform.
Wendell Potter, welcome back.
WENDELL POTTER: Thank you for the opportunity, Bill.
BILL MOYERS: You have as much knowledge as anybody I know about how these insurance companies work. So tell me, what on earth was WellPoint thinking when it jacked up its premiums by nearly 40 percent just as this health care debate was coming to a head?
WENDELL POTTER: Well, these companies are for-profit companies, and they think first and foremost about their shareholders. That's the first stakeholder that they consider. And they know that they have to meet those expectations or their stock prices will suffer. She, Angela Braly, mentioned that she has stock options, so she has the incentive for that stock price to keep going up, because the more it goes up, the more she makes. So that's number one. They're looking after the best interests of the shareholders first, not the best interests of their customers.
BILL MOYERS: But to increase premiums by double digits in 11 states seems to me a pretty stupid thing to do, if you're trying to win friends and influence members of Congress.
WENDELL POTTER: You'd think so, but they spend so much money on lobbyists, on other ways to influence votes in Congress, they've invested many millions of dollars -- all these companies have, over the course of many months and many years to influence their votes--
BILL MOYERS: They just-- the Chamber of Commerce and others says they're going to spend a lot more money in the next month before all of this comes to a head.
WENDELL POTTER: They will. And a lot of that money will come from the insurance companies, from your premiums and mine, that will go into the insurance companies, and they in turn will funnel money into the US Chamber of Commerce and some of their other allies, and also into front groups, to try to kill this bill before it ever reaches the president.
BILL MOYERS: So are you suggesting that they could go ahead and do this really startling increase in premiums, because they know they've got a grip on Congress, through their contributions?
WENDELL POTTER: They do this because they know they can. And they're willing to sacrifice or they're willing to take whatever lumps they might take in the public and before Congress. And you can rest assured that she was well prepared before she went before Congress.
BILL MOYERS: She's not alone, by the way. Look at this list of the total compensation for the top ten healthcare CEOs in 2008. Aetna, 24 million. CIGNA, your old company, 12 million. WellPoint, nine million. That's her. Coventry Health, nine million. Centene, eight million. Amerigroup, five million. Humana, four million. Health Net, four million. Universal American, three million. UnitedHealth Group, compensation, three million. Their profits come from the difference between-- what we pay in premiums and what they pay for our health care, right?
WENDELL POTTER: That's right.
BILL MOYERS: So they have this incentive you talk about to deny health care as often as possible.
WENDELL POTTER: Oh, absolutely. And they deny health care. And the reason why we have so many people who are uninsured and a growing number of people who are underinsured is precisely because of that. They are actually running business away-- they want to get rid of unprofitable customers. They've been doing that for a long time, and Congress is just now catching onto that. Yeah, one of the reasons why they've had to jack up the rates so much in the individual market to make money, is that they have put more people into that market by running off small businesses, for example. They're purging small businesses.
BILL MOYERS: Yeah, I noticed in the story just at the middle of this week that these rate increases are aimed at individuals who can't get coverage through the workplace. They have to buy this on their own, as individuals, and at small businesses. Up to 50 employees. I mean, they have to know, as the Congressman said, that a lot of people cannot afford health insurance. So, what do they expect to happen?
WENDELL POTTER: Well, they don't care, number one, that a lot of people don't-- can't afford insurance. It's highly unlikely that those CEOs that you mentioned have spent much time talking to people who really are in dire straits, who have lost their insurance or have been denied coverage. I was in that boat. It was a revelation to me to come face to face with a lot of those people, and most of those CEOs take great care to be able to make sure that they're not in that kind of a position.
BILL MOYERS: Excuse my growing cynicism at this age and stage, but could this be the briar patch strategy? In other words, they want to get people angry enough to-- for Congress to pass that health care reform with the mandate that delivers millions of new customers to them under penalty of law.
WENDELL POTTER: Well, the way the legislation is structured, this will give them a lot of new business. And millions and millions, billions of dollars in new revenue, and much of it coming from taxpayers in the form of subsidies over ten years-- about half a trillion dollars will come from the US government to help cover the premiums, for people who otherwise couldn't afford to pay those premiums. So yeah, they will win. There's no doubt. They don't like a lot of this legislation. There's much they're trying to kill. And they could live without this bill being passed.
BILL MOYERS: Well, they're doing pretty well as it is.
WENDELL POTTER: Oh, absolutely.
BILL MOYERS: Personally and individually.
WENDELL POTTER: And yeah, exactly, and this system can be sustained quite a long time. And they can get richer and richer as we get more and more underinsured and uninsured.
BILL MOYERS: But let me show you something the president said in his speech on Wednesday. I want to know what you think about it, so let's look at this video.
PRESIDENT BARACK OBAMA: "...many, probably most, Republicans in Congress just have a fundamental disagreement over whether we should have more or less oversight of insurance companies. And if they truly believe that less regulation would lead to higher quality, more affordable health insurance, then they should vote against the proposal I've put forward."
BILL MOYERS: Is the president essentially saying that the gist of this bill is oversight of the insurance industry?
WENDELL POTTER: Much of it is. There is a lot of new oversight of the insurance industry that this legislation would bring at the federal level. There's-- there has not been anywhere close to adequate oversight of the insurance industry at either the federal or state level, and most of the regulation occurs at the state level, and it varies from state to state.
What we're seeing is regulation can work, but it can only work if the insurance departments have adequate resources and if they understand the importance of regulation. And there needs to be a federal component, because a lot of states don't do it adequately. It has been deregulated, or there has been deregulation a lot of states. And we have seen these price increases go up, and in a lot of states, the insurance coverage is woefully inadequate because there aren't many customer protections in the new states.
BILL MOYERS: No one knows right now what the compromise, final legislation will look like-- the Senate bill, the House bill, President Obama's own version that is now in play. But of all that's being discussed and of the likely compromise, what do you like about it? What's good about the most promising compromise?
WENDELL POTTER: Well, first of all, going forward, insurance companies cannot deny us coverage. They will have to insure us. So many of us are born with preexisting conditions, born with preexisting conditions, and are not able to buy insurance at any price. That will end. And that automatically will make sure that a lot of people who are uninsured can get coverage. It will end some of these egregious practices like rescissions, which is a practice of companies going back and canceling your insurance when you start-- when you get sick or injured. That happens all the time. That will become unlawful. A lot of these practices of these insurance companies will be made illegal as they should have been a long time ago.
BILL MOYERS: Do you see anything in this debate, and the provisions that are being debated in Congress right now that would cut one dollar of corporate profits?
WENDELL POTTER: I do. I think that first of all, if you can end the practice of their using preexisting conditions to deny coverage. That's a big, big thing.
WENDELL POTTER: It's a big thing because that is one of the ways that they cut people out of being covered. If they're forced to take all comers, even people who really need insurance, which is what we're really hoping to accomplish with this legislation, that means that they'll have to spend money covering the care that they need. And that's another reason why you have this mandate of trying to make sure that everyone does get in the system, because you have to have everyone in the system before that works.
BILL MOYERS: But at the same time, they're getting, as you say, this mandate which delivers them millions of new customers. So in effect, is it a wash? I mean, they have to spend more money if this legislation passes, but they get more income from the mandated coverage.
WENDELL POTTER: They do. They do that. But I think we need to look at this as a win for consumers as well. Yes, it'll be a win for the insurance companies, but I don't think we're going to wind up with the insurance companies walking away, winning the whole ball game. If we don't do anything right now, that's what they'll-- that's what will happen. They'll win everything.
BILL MOYERS: So preexisting condition is one reason that you like this? You think that might be something good coming out of that?
WENDELL POTTER: Oh, absolutely.
BILL MOYERS: What's another one?
WENDELL POTTER: Increased regulation, as we talked about. And also, this will, if the president's proposals go through, there will be more regulation at the federal level. There will be more effective review of these rates, and the Secretary of HHS will be able to determine if those rate increases are appropriate or not--
BILL MOYERS: Before they're made?
WENDELL POTTER: Before they're made--
BILL MOYERS: Not after the fact. Now, many states has the review after the fact.
BILL MOYERS: So, what else?
WENDELL POTTER: Well and it will also limit the amount of money that people pay out of their own pockets for care. And this is extremely important because one of the ways that these companies are continuing to make more and more money every year is shifting the cost of care from them and from employers to us. One of the women before Congress was talking about her out-of-pocket expenses being in the thousands, maybe nine thousand dollars. Well, Anthem in Ohio got approval to offer a product, a health plan, with a 20 thousand dollar deductible. That's the future. If we don't have reform that makes stuff like that illegal, we're all going to be in the ranks of the under-insured pretty soon.
BILL MOYERS: So I hear Wendell Potter saying that if he were in the Senate or the House, he would vote for this reform?
WENDELL POTTER: I would vote for it. I was distraught when I saw what happened, what I saw the Senate voting on. But then I realized, you know, I studied a lot of these efforts over the past many years to get reform. And often we've come short because we've tried to get the perfect, and we've never been able to get anything as a consequence. So I fear that we may be--
BILL MOYERS: Not since Medicare, right?
WENDELL POTTER: Not since Medicare.
BILL MOYERS: But I remember, Wendell, I remember President Johnson saying, "Well, let's get this bill. It's a flawed bill, 1965, passed. And other Congresses and presidents will come along and improve it over the next several years." That never happened.
WENDELL POTTER: But there have been some improvements. People who are on dialysis, for example, they can you know, they now are qualified for the Medicare program. That's an improvement. And people with disabilities are eligible for Medicare. So, it can change. And who knows? Maybe in the years to come, there can be other substantial changes to Medicare and Medicaid, that will be beneficial to all of us. But yes, this is important. We need to have a foundation. And this may seem to be not an adequate foundation for a lot of people, but there are more than 50 million people in this country who don't have insurance. I don't want to go back and tell them, "I'm sorry. We just couldn't get a good enough bill. So you're going to have to wait to who knows when. Maybe you won't live long enough." 45 thousand people, Bill, die every year because they don't have health insurance coverage. And that's recent. In years to come, that will increase. People can't wait any longer.
BILL MOYERS: Do you see any of the proposals being debated on the Hill reversing the perverse incentives that lead doctors to overtreat the well insured?
WENDELL POTTER: There are not as many controls in this legislation as I think that there could be, but I think that there are some.
And doctors do have an incentive, in many cases, to over prescribe and overtreat. And there are provisions in this bill that address that.
BILL MOYERS: Do you think there are enough provisions that will contain the soaring cost?
WENDELL POTTER: I think it's a beginning. I think you will see that. The private market has lost its ability to control these costs, so the federal government has to step in and play some role. And I think that we'll begin to see that with this legislation.
BILL MOYERS: So you're saying what others have been saying, that doing nothing is not an option?
WENDELL POTTER: It's not an option. The free market does not work in health care like it does in other sectors of the economy. In fact, it works just the opposite. And what's happening is that competition is driving up cost. It's not controlling cost. It's driving them up. It doesn't work like other sectors of the economy. The hospitals and the doctors, now that they are bigger and more powerful and have more bargaining clout, can get more at the bargaining table, in terms of increases in what the insurance companies pay them. So that's why costs keep going up. The insurance companies have lost the ability to control costs. And the way they're continuing to make money is to shift more and more of the cost to us, through these high deductible plans that they're marketing.
BILL MOYERS: So Senator Potter votes for it. It passes. The president signs it. Now you're facing an opponent in this upcoming November election. Your opponent runs ads saying, "Senator Potter voted for a massive government takeover of health care. Senator Potter voted to put bureaucrats in between you and your doctor." So you get-- you're getting bombarded with all of these ads. How do you respond?
WENDELL POTTER: Well, I would-- by facts, for number one. But also by-- one of the things that I think advocates of reform have not done is to understand how the opponents play the political game. And they've been talking about this being a government takeover of the health care system for a long time. They've been engaging in fear mongering even before the first bill was introduced in either the House or the Senate. They knew what was coming, and then their strategy was to try to manipulate public opinion. So the incumbents, the Democrats, are going to have to go back to the reasons why we're having this debate in the first place, and to say, "Look, what would happen if we didn't do anything? Here's what would have happened to you. You cannot rest assured that you're going to be able to keep your insurance, if you lose your job. You probably already know somebody who's lost their job and their coverage. It might be someone in your own family. Think about your own children. Think about what could happen if we didn't-- could have happened if we didn't act." This might be the most important thing that any member of Congress right now will vote on. And I would certainly want to make sure that I voted the right way.
BILL MOYERS: So let's go back to your unrepentant days, when you were in the war room of the health insurance industry and you were trying to figure out PR strategies to advance the interests of your company and the industry. What would you be advising right now?
WENDELL POTTER: I'd be advising that a lot of the money that they have available to them for PR and advertising be funneled into organizations like the US Chamber of Commerce, the National Federation of Independent Business, and other groups that are their natural allies and have been for many years, to advertise all across the country. And in particular, in states and districts where there might be some vulnerable members of Congress, to call this a government takeover. To try to continue to scare people. We'll see that, to scare people away from this. And at the same time, try to say that we are in favor of reform. We just need to have a bipartisan approach to reform. Those are words that sound good, so--
WENDELL POTTER: --so continue with its duplicitous campaign. Why? Because people like--
BILL MOYERS: Why do they put-- why do they put bipartisan on it, when the Republicans haven't yielded an inch?
WENDELL POTTER: Because they know that the public likes the idea of bipartisanship. And the public doesn't realize that the realities in Washington are making bipartisanship virtually impossible, at least on this issue and on many other issues. It's not achievable.
BILL MOYERS: So Wendell, you reluctantly are going to support this bill?
BILL MOYERS: What don't you like about it?
WENDELL POTTER: I don't like the fact that it doesn't include the public option. That was so much a part of the House bill, even though it was watered down. It was a good thing to have included, and I regret that. And I hope that maybe in future years, Congress can revisit that. And I think they will, if they're seeing that the reform doesn't work as envisioned.
BILL MOYERS: So you would say yes, and then fight again for another day to make it better.
WENDELL POTTER: I would vote for it. Is it the be all and end all? No, it's not. There are other things that I think will have to come back in years to come. But wouldn't you rather, and I think wouldn't most Americans rather that we have something to start from rather than starting from scratch the next time? It's very hard to build up to doing this in the first place. And keep in mind that the special interests have almost an unlimited amount of money to spend to influence the results. I'm frankly pretty amazed that we're getting this close to passing something.
BILL MOYERS: Wendell Potter, it's been good to see you again.
WENDELL POTTER: Thank you very much, Bill.
BILL MOYERS: We'll be back in just a couple of minutes with my next guest, Dr. Marcia Angell, and more on the health care reform fight. Please take this opportunity, in the mean time to pick up your phone or go to your computer and make a pledge to this public station. In these difficult times, we need analysis of the news and issues that affect each of us more than ever. Your pledge keeps the candle in the window of this local station. Thank you.


Tuesday, April 13, 2010

Charting a Course for Healthcare Quality Improvement: Data-Driven Strategies for Eliminating Health Disparities

As our nation continues to pursue comprehensive health care reform, the need to improve health care quality and achieve equitable care for all Americans remains a critical issue that must be addressed. High-quality health care is seldom consisitently distributed across populations, and vulnerable groups – such as racial, ethnic, and linguistic minorities – are more likely to be negatively affected by disparities in health care.

On March 25, the Engelberg Center for Health Care Reform hosted a national conference to begin to address health care quality issues faced by vulnerable communities. Key stakeholders came together to:
  • Advance strategies for improved data collection, integration, and utilization activities, as well as disparities measurement to promote health care equity; and
  • Identify best practices for collecting and reporting race, ethnicity, and primary language data, as well as determine practical, consensus-driven steps to measure and use these data to improve quality of care.
After welcoming remarks from Center Director Mark McClellan, Olivia Carter-Pokras and John Lumpkin offered opening remarks on health care equity, followed by a plenary on measuring race, ethnicity and language data.

Vice Admiral Regina M. Benjamin, surgeon general of the United States, offered keynote remarks, discussing the critical need for improved health care quality and equitable care for all Americans.

A plenary session focused on incentivizing quality as a means of promoting equity in the health care enterprise, followed by closing remarks from Marsha Lillie-Blanton and Mark McClellan.

Event Materials