Saturday, July 25, 2009

Why I'm optimistic healthcare reform will pass this year

I have been optimistic about healthcare reform since a few years ago when I met a then state Senator Obama as he was running for US Senator. His passion about the issue struck me even then... and I was on his bandwagon early. My friends who ask me what I think of "The Plan" hear the following from me - it's not about the specifics (which we really don't know yet), it's about acknowledging the failure of our current system to create a sustainable system that takes care of everyone, and the potential to improve in so many ways by aligning incentives and allowing enough freedom to system create innovations that work.

And when I hear the pessimists say it won't pass, I truly believe that many more people want it to pass than do not. This recent article provides a good analysis of that subject:
Lobbyists the silver lining in health care storm?

A few crucial snippets:
The drug industry, the American Medical Association, hospital groups and the insurance lobby are all saying Congress must make major changes this year. Television ads paid for by drug companies and insurers continued to emphasize the benefits of a health care overhaul — not the groups' objections to some of the proposals.

"My gut is telling me that something major can pass because all the people who could kill it are still at the table," said Ken Thorpe, chairman of health policy at Emory University in Atlanta. "Everybody has issues with bits and pieces of it, but all these groups want to get something done this year." As a senior official at the Health and Human Services department in the 1990s, Thorpe was deeply involved in the Clinton administration's failed effort.

And as much as these forces were against change in the past, their strength will be one of the reasons we will be able to move forward in the future.

Friday, July 17, 2009

Meaningful Use Definition - Updated

Congrats to the committee for quickly getting input and continuing to evolve this hotly debated area. Here is the link to the updated matrix on "Meaningful Use Definition":

Some of the clarifications they note:
1 The HIT Policy Committee recommends that incentives be paid according to an “adoption year” timeframe rather than a calendar year timeframe. Under this scenario, qualifying for the first-year incentive payment would be assessed using the “2011 Measures.” The payment rate and phaseout of payments would follow the calendar dates in the statute, but qualifying for incentives would use the “adoption-year” approach. [Extra info: a ppt slide clarifies latest year to start adoption is 2014, and in that case, max amount of incentive would be $24,000 rather than $44,000].

2 CPOE requires computer-based entry by providers of orders (medication, laboratory, procedure, diagnostic imaging, immunization, referral) but electronic interfaces to receiving entities are not required in 2011

3 Race and ethnicity codes should follow federal guidelines (see Census Bureau)

Things I like
- Implement one clinical decision rule relevant to high clinical priority: That provides value, is realistic with most EMRs, and ideally "gets the ball rolling". Of course, this depends on what they allow as a "clinical decision rule"

Things that worry me:
- Provide patient access to electronic health information: very few EMRs do that now, and yet they moved it up to 2011 ("Year One" measures) - that seems to be wishful thinking.
- % of all medications entered into EHR as generic, when generic options exist in the relevant drug class: I have no idea how one would measure that, and furthermore- it is not very realistic. For example, I presribe a lot of meds with their brand name, but check off "may substitute" - so the patient can make the final choice as to whether they want the generic. Also, to be honest- it's a lot easier to manage a med list made up of brnad names than generic ones!
- Does ePrescribing mean prescriptions transmitted electronically?: I continue to be baffled as to whether this will truly be a requirement as compared to just creating the Rx via an EMR. Specifically, if I create a prescription online (which implies it is electronic and I do get clinical decision support/alerts) and then print it for the patient - shouldn't that be good enough at least to start with? Why insiste that I also have to send it via EDI to a pharmacy - especially in a world where patients don't always know where they want it sent, and not all pharmacies support this process yet. I do some occasional eRx transmittals, and I've gotten upset calls from some patients because the pharmacy truly does not understand the concept (usually, they have the IT, they don't have the training).
Link to full text of HITECH bill: