Sunday, September 24, 2006

Welcome to Autumn

From Mike Leavitt, ex-CMS head, comes this quote via

Leavitt: U.S. Needs EHRs, Price TransparencySeptember 22, 2006
The U.S. health care system needs integrated electronic health records and billing programs, as well as more transparency on the price and quality of services, HHS Secretary Mike Leavitt told the Medical Society of Virginia on Thursday, the Richmond Times-Dispatch reports. Leavitt said hospitals are spending millions of dollars on new EHR systems, but the systems are not interoperable. Leavitt also touted President Bush's transparency initiative, which was announced last month (Smith, Richmond Times-Dispatch, 9/22).Bush last month signed an executive order that requires HHS, the Department of Defense, the Department of Veterans Affairs and the Office of Personnel Management to collect more information about the quality and cost of health care they provide and to share that data with one another and with beneficiaries (iHealthBeat, 8/23).According to Leavitt, "No one knows what they pay for their health care services. No one knows cost or quality. ... We don't have any reason to care financially." Physicians questioned Leavitt about the scheduled 5% reduction to Medicare payments and the costs of implementing EHR systems, the Times-Dispatch reports. "You really cannot plan ahead and make a major investment for (IT) or electronic medical records unless we hear coming from the federal government that we are going to have some support," said family physician David Ellington (Smith, Richmond Times-Dispatch, 9/22).

Other news about Price Transparency::

Bush Signs Health Care Transparency Executive OrderAugust 23, 2006
President Bush on Tuesday signed an executive order that requires HHS, the Department of Defense, the Department of Veterans Affairs and the Office of Personnel Management to collect more information about the quality and cost of health care they provide and to share that data with one another and with beneficiaries, the Washington Post reports (Fletcher, Washington Post, 8/23). The order directs the agencies to work with the private sector and other government agencies to develop and enact programs to measure quality of care. The agencies would work to identify practices that promote high-quality care. The order would require the agencies to compile information on the prices they pay for common services available to their members. HHS Secretary Mike Leavitt said agencies must have the new programs in operation by Jan. 1, 2007 (iHealthBeat, 8/22). The order would create a resource for information on providers' quality and prices, which would be available to consumers, Government Computer News reports (Mosquera, Government Computer News, 8/22).Bush said the order sends a message to health care providers that "in order to do business with the federal government, you've got to show us your prices" (Gerstenzang, Los Angeles Times, 8/23). "The fact is, if you have excellent information about quality, about service and about price, people make good decisions," Bush said (Washington Post, 8/23). The order does not detail how providers would pay for increased costs related to establishing and meeting data-sharing standards or how providers would show charges for specific services (Los Angeles Times, 8/23). The Wall Street Journal reports that "[m]uch remains to be seen" on how the order is enacted "because different interest groups want different standards" (Zhang, Wall Street Journal, 8/23). Reaction Karen Ignagni, president of America's Health Insurance Plans, said the order "rewards the delivery of high-quality care, fosters an interoperable health care system, and takes steps to ensure that consumers are equipped with the best available information they need to make health care decisions" (Los Angeles Times, 8/23). John Engler, president of the National Association of Manufacturers, said, "Greater transparency of cost and performance information will help consumers make more informed decisions regarding their health care. Additionally, adoption of health IT standards will further improve health care quality, streamline inefficient processes and reduce costs that are burdening our businesses." Rep. Patrick Kennedy (D-R.I.) said he supported the order. "The government buys so much health care that, if the various agencies coordinate their efforts to drive quality and efficiency, it can make a huge difference," Kennedy said. He added that "patient privacy must be a paramount concern" (CQ Today, 8/22). Edward Langston, a board member of the American Medical Association, said pressuring physicians to be more transparent about their prices might not be effective because most health care consumers pay physicians through the government, insurers or other third parties, which set the prices (Wall Street Journal, 8/23). Stephen Davidson, a professor of health care management and management policy at Boston University's School of Management, said "These orders won't have much effect at all. He said most physicians do not have interoperable software systems, and even if they did, "the benefits of those systems go to the payers and the patients" (Kolbasuk McGee, InformationWeek, 8/22). Broadcast CoveragePBS' "Nightly Business Report" on Tuesday reported on Bush's signing of the measure. The segment includes comments from Robert Berenson, health policy fellow at the Urban Institute; Bush; and William Fried, medical director for Aetna (Dhue, "Nightly Business Report," PBS, 8/22). The complete transcript is available online.

Bush Says Hospitals Should Disclose Prices 05/02/2006

Bush Mentions Health IT in State of the Union Speech 02/01/2006

HIMSS Asks Bush To Restate Call for EHRs 01/30/2006

Also noted in these reports was the fact that many hospitals are purchasing EMRs, but they are not interoperable.

The AMA has clearly stated that there is not much motivation, nor ability for providers to invest in IT until the flawed "SGR" formula which kicks in each year to reduce payments by 5% per annum is corrected. For the past 15 years or more many providers have had a constant battle to maintain solvency, let alone create sustainable business plans for capital investment, such as Health IT.

RHIOs face competition for health care dollars needed for medical technology, diagnostic advances and technologic procedural advances.

Any benefits accrued from interoperability, funded by providers is garnered more by payors
and the regulators.


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