VETS Act seeks to increase access to telemedicine for veterans

WASHINGTON – Fourteen House members from both sides of the aisle are joining forces to sponsor a bill aimed at improving access to telemedicine services for veterans.

The Veterans E-Health & Telemedicine Support (VETS) Act of 2012 (H.R. 6107) would enable providers affiliated with the Department of Veterans Affairs to deliver telemedicine services across state lines, eliminating a requirement that the providers be licensed in the same state as their patients. The bill was introduced last week by House members Glenn Thompson, (R-Pa.) and Charles Rangel (D-N.Y.).

The bill follows several recent moves by the federal government to adopt telemedicine as a means of treating servicemembers, veterans and their families. So far this year, the VA has dropped co-payments charged to veterans for telehealth consultations and is setting a goal of providing 200,000 remote consultations by the end of this year (up from 140,000 last year). Also, last week the VA announced the launch of the $15 million, three-year Specialty Care Access Network-Extension for Community Healthcare Outcomes (SCAN-ECHO) program, designed to help rural healthcare providers receive training and assistance in delivering telemedicine services to veterans.

In a letter announcing the VETS Act, Rangel said the easing of restrictions on telemedicine would greatly enhance the use of telemental health, allowing providers to reach distant and remote veterans who are dealing with mental health issues and don't want to travel to a VA clinic. A RAND Corp. survey conducted earlier this year found that nearly 20 percent of military personnel returning from Iraq and Afghanistan have shown symptoms of post-traumatic stress disorder, or PTSD.

"The bipartisan legislation would allow Veterans Affairs (VA) health professionals, including contractors, to practice telemedicine across state borders if they are qualified and practice within the scope of their authorized federal duties, a big improvement on the status quo; currently, overly cumbersome location requirements can make it difficult for veterans – especially those struggling with mental health issues – to get the help they need and deserve," Rangel's letter said.

"Nearly 18 veterans commit suicide every day," he added. "Each one is a tragedy. By increasing the ease of access to mental health professionals, my hope is that this bill will help veterans struggling with mental health conditions."

"In 2011, Congress passed the Servicemembers Telemedicine & E-Health Portability Act, through which the Department of Defense is now working to expand access to our servicemembers through various existing programs," Thompson added in his announcement. "The VETS Act will enable the VA to implement the same reforms and provide greater access to care that our veterans need, have earned and rightfully deserve."

Both congressmen said the bill was introduced with the support of 12 additional Congress members from both sides of the aisle and has been endorsed by the American Telemedicine Association, the American Foundation for Suicide Prevention and the Veterans of Foreign Wars.

According to the Army Times, an Army study has found that telehealth is an effective medium for delivering a wide range of behavioral therapies targeting PTSD among isolated or dispersed soldiers, especially members of the National Guard Reserve, but the process is hindered by state laws that require providers to hold licenses in each state in which they deliver care.

“The requirement was for a provider to have multiple licenses, which can take months,” said Gary Capistrant, senior director of public policy for the ATA – which has long campaigned for cross-state licensing for telemedicine services – in the Army Times article. “It may be you just have one visit with a person in a particular state, and you’re not going to go through that for one person."

KLAS: More providers forming enterprise imaging strategies

OREM, UT – A new report from KLAS finds most healthcare providers have begun putting into place an enterprise strategy for imaging, with the goal of getting "the right image to the right place at the right time."

The study, "Enterprise Imaging 2012: Provider's Strategies and Insights," reveals that vendor-neutral archives (VNA) and PACS enterprise archive solutions are emerging as the top two preferred approaches for most providers.

GE and Philips were the vendors mentioned most often overall in the study as strategic enterprise imaging partners, according to KLAS, and every GE and Philips customer interviewed considered their vendor to be part of their go-forward imaging strategy – especially those going for a PACS enterprise archive centric strategy. Fuji, while not cited as often as the other two, also seems to have a strong PACS enterprise archive offering.

Agfa and Merge were the most-often cited vendors for a VNA-centric strategy, according to KLAS, which reports that Agfa customers using the IMPAX Data Center (IDC) remain committed, despite early indications that a lukewarm PACS experience will affect the IDC experience. Merge has many of the needed pieces, the study adds, but providers are still waiting for integration; Merge customers are looking forward to what they will be able to do with Merge's iConnect platform.

Acuo and TeraMedica are the primary non-PACS players in the VNA space. In most cases, early trends suggest that TeraMedica customers are pleased with the value of the system and hint toward favorable enterprise DICOM management, according to the report, which found that several providers were also leveraging TeraMedica's ability to store other clinical content in its native format.

Acuo clients say their vendor's core strength is in image distribution and data migration. Their increasing number of vendor partnerships and growing mindshare in the VNA space suggest that Acuo is a viable archive option for those who do not want to rely solely on a PACS archive.

Of the providers interviewed by KLAS, 27 percent indicate that a VNA would be central to their enterprise imaging.

"Image storage is a necessity, no matter what option is chosen," said Ben Brown, imaging research director at KLAS and author of the report. "As providers start to bring in more studies and the studies themselves increase in size, the need for storage will increase. In addition, as a provider explained, images will need to be managed as well as stored."

Carestream, Cerner, Dell, DR Systems, EMC, McKesson, ScImage, Sectra and Siemens are also mentioned in the report.

Medicaid Expansion: Who's In? Who's Out?

Courtesy of the Center for American Progress

In the week since the Supreme Court upheld almost all of President Obama's health care law, some of the biggest action has been on the Medicaid front, where the administration definitely lost.

Until last week, the Affordable Care Act was expected to drive an expansion of Medicaid to the tune of about 17 million more people being covered over the next 10 years.

The Affordable Care Act, as written, would have required states to provide Medicaid coverage to adults, whether they have children or not, with incomes up to 133 percent of the federal poverty level.

Now that expansion is optional, and it's unclear how many uninsured people will ultimately gain coverage under the law.

 

Medicaid is paid for with a mix of state and federal funds. So a big expansion could get expensive for states, even though the federal government would kick in a lot of the extra dough.

"It's going to cost Florida $1.9 billion a year," Florida Republican Gov. Rick Scott said on CNBC's Squawk Box Monday. He said Florida wouldn't go along with it.

Scott's claim is too high, according to an independent analysis by Politifact, which put the cost of the additional Medicaid coverage at a little over $500 million a year. And most of those costs wouldn't pop up until 2020.

But five states, including Florida, have said they're out as of Thursday morning, according to The Daily Briefing from the Advisory Board Co.

Lots of states now offer Medicaid only to adults with children, and the income cutoff is generally much less generous, too.

The law says the feds could withhold all federal Medicaid funds from states that didn't comply. But the high court ruled that hammer was just too extreme.

A majority held:

"The threatened loss of over 10 percent of a State's overall budget is economic dragooning that leaves the States with no real option but to acquiesce in the Medicaid expansion."

So the states can skip of the expansion and only miss out on those federal funds that would have gone toward it.

The interactive chart from the Center for American Progress, embedded above with its permission, shows what's at stake. Hover over a state to see how many people could be affected.

As Julie Rovner reported last week, many low-income people who don't qualify for Medicaid now won't be eligible to for the next best alternative, a tax credit to subsidize the purchase of health insurance through a state exchanges.

Rovner is taking another look at how the Medicaid choices are unfolding. Stay tuned.

Six great gadgets to buy for your workouts

Skipping your workout can be a huge temptation when the sun blazes overhead and a cool oasis beckons. USA TODAY picked six great gadgets that will help you forget the heat and stay active this summer.

Born to ride

Taking your music on long bike rides gives you the extra kick you need to climb hills and endure long flats. FoxL is a super-light Bluetooth system by Soundmatters that fits on handlebars. It is 5.6 inches long and weighs 9.5 ounces. The stereo sound is rich � and safer than wearing ear buds attached to a phone or MP3 player.

The lithium battery might last longer than your legs: It has up to five hours of life and is rechargeable. Spend a couple seconds syncing your iPhone or Blackberry and hit the road. If you're hooked on a bike computer and have it mounted on one side of your handlebars, this unit fits beside it or on the other side. Speakers, $199; mounting kit, $34.

Blissed-out toes

Running on hot asphalt or playing a game on artificial turf quickly overheats and tires feet. The makers of Balega's Drynamix socks describe them as having an "air-conditioning" fabric system. The moisture management fibers and design work to keep feet cool and dry. Styles include crew cut, low cut and no-show. They have names such as Ventilator, Enduro, Ultra, Pro Pacer and All-Out Trail. $9.95.

Drink on the go

Staying hydrated has always been a hot-weather must, but knowing how to carry fluids has gotten trickier as some materials used in the bottles have been found unsafe. Now both Nike and Under Armour make BPA-free sculpted bottles with flip-top openers. The design makes them super-easy to hang on to and open with one hand. These are dishwasher safe and come in fun, bright colors. $20.

Ultra-green vision

Having a cool-looking pair of shades is half the fun. One style (Penny Lane) is a throwback to the '60s, but Zeal Optics has glasses for every activity level and stamps each with "ecological responsibility." The Boulder, Colo., company uses bio-powered resin frames (green-speak for making the resin from castor plant oil instead of crude oil, which releases carbon dioxide during manufacturing and harms the ecosystem). The glasses are polarized, reduce the sun's glare by 99% and cut 100% of UVA, UVB and UVC rays. Prices range from $100-$200.

Spider-Man shoes

One of Teva's new products is a super-grippy water adventure shoe that is stylish enough to wear later to the bar or movies. We love the classic look and the major upgrades, especially the "sticky bottoms" made with Spider Rubber. Teva says it's their highest-performing water shoe yet: The bottoms adhered to a grease-covered aluminum ramp during testing. So no problem for these brutes to cling to mossy stones in a river or hang on to a damp sailboat deck. The fabric keeps your foot dry and also breathes. $90.

Sounds of summer

Get lost listening to one of this season's best-selling authors during lap swims or crank up your favorite tunes while waiting for a wave to ride. Fitness Technologies claims to make the smallest waterproof MP3 player. UwaterG4 weighs less than an ounce, holds 4G of data (1,000-1,200 songs) and is guaranteed for up to 10 feet underwater. Attach it to eye goggles for lap swims or an armband for other water activities. The earplugs are equipped with a 36-inch red cord and a twist-and-lock jack that keeps out water. $79.95.

NYeC's 'public utility' model works well for regional HIEs

NEW YORK – In the second half of 2011, the New York eHealth Collaborative (NYeC) shifted its role from a policy convener to a service provider that runs the health information exchange (HIE) infrastructure for the local HIEs and regional health information organizations (RHIOs) like a public utility. That shift was the "biggest necessary change" that is propelling the Statewide Health Information Network of New York (SHIN-NY) forward, according to Irene Koch, executive director of the Brooklyn Health Information Exchange (BHIX).

"Instead of allowing SHIN-NY to develop organically through just policy and have the RHIOs maintain their infrastructure independently, NYeC being able to offer a centralized, efficient model made a lot of sense to those of us who have patients who can really benefit from a deeper, more integrated system," Koch said.

While BHIX has a lot of data and value, it sits in New York City and serves a population that can easily access multiple HIEs and RHIOs. "The data needs to travel across a wider geography than just any one borough or region can achieve right now," Koch explained. Also, despite the handful of RHIOs in New York City, there's still a lot of fragmentation in terms of provider affiliation with different RHIOs, which impacts data flow. For example, some providers in Queens may have data flowing in BHIX, or some Brooklyn providers may have data flowing in another RHIO.

"It was always important for us to move along the path toward inter-regional interoperability. For us, we want to be right at the lead for that," Koch said. BHIX is indeed at the forefront in NYeC's first step toward connecting New York State, as one of the first three RHIOs (along with e-Health Network of Long Island and THINC) in the downstate region to participate in the SHIN-NY. Part of BHIX’s decision to participate was predicated on NYeC being able to combine and take over the infrastructure, which includes financing the operation of the infrastructure. Once more RHIOs come on board, SHIN-NY would evolve to a collective business model. Taking this step furthers BHIX’s mission to deliver a product at better price points in order to benefit its members, Koch said.

"We knew from the start that things had to be flexible and that things would evolve," she said. "We're so pleased that the work we’ve done over these past several years is the kind of flexible infrastructure that will form a key component of the SHIN-NY going forward and we're very pleased at the same time to be among the first to partake from that and get the benefit of what shared data will mean for our providers and their patients."

On the technical side, BHIX is consulting with NYeC to assist the organization in the transition to maintain the infrastructure and to share best practices and lessons learned. BHIX's infrastructure, which combines InterSystems HealthShare and IBM Initiate software, and internally built applications on top of the software within a privacy framework, is forming the reference implementation for the SHIN-NY. "NYeC is looking to us to help them understand and help them take over and run what we've built to support the entire SHIN-NY," Koch said. As RHIOs and newly formed local HIEs join SHIN-NY, having the reference implementation in place will allow for interoperability more quickly. At the same time, as NYeC builds on the infrastructure and makes it available for supporting interoperability with many different RHIOs, BHIX will have flexibility to do innovative projects with its stakeholders.

The RHIO is continuing its patient and community education about the benefits of HIE, as well as growing its membership through the build-out of connections and interfaces to new providers and discussions with payers regarding both support for the exchange and new reimbursement models such as Medicaid health homes and accountable care organizations. "This is what health information exchange was made for," she said.

When BHIX was established, the focus was on aggregating data to deliver patient-centric views for care coordination. HIE is now being used to support new reimbursement models that are looking to coordinate care across organizations. Maimonides Medical Center in Brooklyn, a BHIX participant, is an early leader in this area, using HIE features as a tool for coordinating care. For example, event notifications – ED admissions, discharges and so on – are being sent in real time to care coordinators who are responsible for tracking and managing a panel of patients with mental health issues so they can follow up in a timely manner.

For the Maimonides project, BHIX is expanding those event notifications to a broader panel of patients who are suffering from schizophrenia and bipolar disorders. "These event notifications are just the tip of the iceberg," Koch said. "We can trigger alerts for abnormal lab values for a particular panel of patients and really help these care coordinators get the information that they need at the right time so that they’re able to follow up more efficiently."

BHIX is also involved in New York State’s Medicaid Health Homes program. The RHIO got a head start, getting some functionalities live, thanks to Brooklyn being named to begin in the early round and Maimonides being named one of the four health home provider leads in Brooklyn. "As they refine and grow their clinical and technical program, we will support them every step of the way," Koch said.

9 ways future EHRs need to support ACOs

Just a few years ago, the industry saw most vendors touting their support for meaningful use. Today, that focus is slowly shifting to the "ready for ACO" mentality. But unlike meaningful use, said Shahid Shah, software analyst and author of the blog, The Health IT Guy, the technology required for ACOs isn't as well defined, leaving most vendors' claims "untestable."

"Don’t be fooled into buying health IT applications that promote an 'ACO in a box' solution," said Shah. "There is no such technology, and there really can’t be. ACOs are not a technology problem; they are a business model problem first, and until the business side has decided how it will identify savings – and share those savings – any purchase will likely be useless.

"The EHR systems and IT required for MU is a quite different from what will be required for ACOs," Shah continued. "It will be nowhere as easy for existing legacy EHRs to simply retool their current platforms, like they did for MU."

With that said, Shah outlines nine ways future EHRs need to support ACOs.

1. Sophisticated patient relationship management (PRM). According to Shah, today's EHRs are more document management systems, rather than sophisticated, customer/patient relationship management systems. "For them to be really useful in ACO environments, they will need to support outreach, communication, patient engagement, and similar features we're more accustomed to seeing, from marketing automation systems than transactional systems."

2. Getting data from your systems through business intelligence and reporting. Meaningful use in its first stage, said Shah, is all about getting data into your systems, all with little outward sharing. "Data collection is something we've been doing for decades – even before MU came along, we knew how to build systems that can collect and store data bases," he said. What most people have never been good at though, he continued, is getting data out of a system in a useful way. "Now with ACOs, business intelligence reporting, and analytics across dozens of disparate systems is a real requirement," said Shah. "Today we all have problems getting data out from a single departmental EHR to help with billing inquiries and clinical decisions support." With ACOs, he said, you not only have to pull data and tie it together with departmental and local systems in your organization, but outside your organization as well.

3. Data integration for analytics capabilities. "This doesn't mean we toss in HL7 routers and hope for the best," said Shah. Most IT environments have the ability to send messages from one system to another. "That's called 'transferring' data, which we've been doing for decades," he said. "Integrating data, though, means much more – the ability to store and understand information in data marts, data warehouses, and clinical data stores and repositories from a variety of sources." Having an EHR, he added, doesn't mean you're ready for data integration; instead, you need tools "beyond what health IT firms provide," he said. "Traditional data integration vendors should be getting most of your attention here, as opposed to healthcare-specific."

4.Granular clinical data sharing. The ability to integrate data into your own system is one thing, said Shah, but granularly sharing that same data across ambulatory practices, lab partners, and other shared providers is going to require HIEs of varying levels of sophistication. "Early on, you might even need to try to bypass the HIEs and create your own local exchange using the Direct Project to make sure you're in control." Using the Direct Project to transfer secure data between partners — while building your data marts and warehouses outside traditional EHRs – will be "your best architecture bet," he said.

Continued on the next page.

Finding Out If Your Health Insurer Is Providing Value for Your Premiums

When hardworking Americans pay for health insurance for their families and themselves, most of what they are paying for should be medical care, not CEO bonuses, slick advertising or administrative costs. That is why one of the pillars of the Affordable Care Act is to help consumers get good value for their health insurance premium dollars.

The health care reform law holds health insurance companies accountable to consumers and ensures that consumers are reimbursed when insurers don�t meet a fair standard of spending premium dollars on care. Because of the new �80/20 rule� in the Affordable Care Act, insurance companies generally must spend at least 80 cents of every dollar you pay in premiums on your health care or activities that improve health care quality. If the insurer fails to meet this standard � the �medical loss ratio� � in any given year, it must pay its policyholders the difference. This could mean a rebate check or a reduction in future premiums for you and your family.

Under the health care law, nearly 13 million Americans are expected to benefit from $1.1 billion in rebates from insurance companies due by Aug. 1, 2012, because of the 80/20 rule. All insurance companies for the first time will send their policyholders a letter informing them of the rule and whether the insurer met the standard. Those that do not meet the 80/20 rule standard will inform consumers that they will receive a rebate.

Want to know whether your health insurance company is required to provide a rebate?� Today, on HealthCare.gov, we�re launching a new tool that will allow you to enter your state and health insurance company information and see the average rebate your insurer is required to pay. See the sample screenshots below:

But remember, that�s just an average, and you may see the �rebate� in a number of ways. These include:

A lump-sum reimbursement to the same account that was used to pay your premium if it was paid by credit card or debit card;A rebate check to you in the mail;A direct reduction in your future premiums; orYour employer using one of the above rebate methods, or applying the rebate in a manner that benefits employees.

Many Americans are working hard to provide for their families and they do not deserve to have their health insurance premium dollars wasted on excessive administrative costs and profits. The 80/20 rule is one of the many ways that the Affordable Care Act is making sure that millions of Americans get value for their premium dollars.

For a detailed breakdown of these rebates by state and by market, please visit
http://www.healthcare.gov/law/resources/reports/mlr-rebates06212012a.html

To learn more about the 80/20 rule provision in the Affordable Care Act, please see http://www.healthcare.gov/law/features/costs/value-for-premium/index.html

List of top children's hospitals is guide to quality care

U.S. News & World Report says its ranking of best children's hospitals, out Tuesday, puts an emphasis on institutions with top care in at least one of 10 specialties. A total of 80 hospitals excelled in at least one area, but its honor roll focuses on a dozen that ranked high in at least three specialties.

Although the highest ranked centers, Boston's Children's Hospital and Children's Hospital of Philadelphia, also topped last year's chart, the criteria were a bit different in the list's fifth year.

Health rankings editor Avery Comarow says reputation still factors into which centers rank best, but it's a shrinking role. He says "for reasons that may or may not be justified," the most esteemed hospitals tended to overshadow less recommended centers that still offered top care.

"It's important to remember that these rankings are not for routine pediatric care," he says. "They're for kids who just need the ultimate in care and I think that most parents are willing to travel at least some distance for that."

Gillian Ray, the Children's Hospital Association public relations director, says the list is informative. However, parents shouldn't assume they can only receive quality care at one of the 12 top-tier hospitals.

"Before you think you have to travel across the country for the top care, make sure you know what's in your own backyard," Ray says. "There are children's hospitals in most major areas and most kids are within two or three hours of a children's hospital."

Ray says parents could ensure their local hospital can care for young patients by asking about staff (for instance, whether there are surgeons trained in pediatric care), and such medical equipment as kid-sized intubation tubes and needles.

Comarow says the list should provide parents with a starting point. If a hospital tells a family they do "a lot of work" in a difficult heart surgery, they should still ask for a full picture.

"You have to say, 'Well, what does that mean? What is a lot of work, who's the best person there and what success rate does she have? What's the death rate and what are the complications?' " Comarow says. "It's important to find the person who can give your child what he or she needs and there's no getting around the fact that that takes work and there's no shortcuts."

The full rankings and methodology can be read at www.usnews.com/childrenshospitals.

Replacement options are plentiful for lost 'loveys'

When Catharine Blake told her daughter Francesca, 3, not to bury her prized Gumby figure in the sand on a beach in Well, Maine, two summers ago, Francesca didn't listen. An hour later, Gumby was gone.

"I panicked and started digging up hole after hole and tried to figure out the general area it was in," recalls Blake, 39. "I probably spent 45 minutes doing this while Francesca was crying and upset. I must have looked like a loon."

Blake, a psychotherapist in Andover, Mass., says she stopped the search when "the reasonable part" of her brain kicked in. Her stepfather recalled seeing a Gumby in a nearby store, so Blake texted her mother, who was out shopping.

When the beachgoers returned home, a familiar green plastic figure was on the porch.

Francesca was overjoyed. "I promise I'll never lose you again," she told Gumby. Two years later, she still talks about Gumby's return � though he now lives at the bottom of her toy box, Blake says.

Tips to avoid potential problems

Buy duplicates of a beloved item as soon as you realize your child has a favorite; switch them regularly so the child doesn�t realize there�s more than one.

Set limits on where the lovey goes, such as never leaving the house, or having a certain item for car rides but another for use inside the house or crib. If that doesn�t work, keep a close eye on the toy when traveling. �Do not leave it in the hotel bed tangled up in the sheets,� said Lisa Oliver, founder of LostMyLovey.com. �Many moms have told me the sad story of leaving lovey in the bed, and hotel maids scooping it up in the wash, never to be seen again.�

Take photos of the item before it goes missing, so you�ll have an image of the item you are searching for, says Rosemary Bouchet of Plush Memories. Photos are handy if you need to search online lost-and-found boards or make �Missing� signs to post in the neighborhood.

Young kids often get attached to a particular object or toy for comfort; these items are sometimes known as loveys or transitional or comfort objects. When they go missing, parents often are as distressed as their child.

The psychology behind lost loveys

Why are certain toys and stuffed animals so important to young children? They represent secure relationships with caregivers, says Stephanie Pratola, a psychologist in Salem, Va. She says loveys can help kids feel more secure in new situations and help them separate from parents or other caregivers.

When loveys get lost, kids pick up on a parent's reaction, she adds. "Frantically searching for a lost toy or speeding back to the place it was lost probably will create additional anxiety for the child. Parents might sometimes inadvertently overly encourage the attachment to a particular object."

Ultimately, whether or not a lost item ever surfaces, most kids move on. "Most leave them behind when they're ready, without difficulty," Pratola says.

But sometimes, seeking a lost item can become a sweet childhood experience.

Kathleen Reilly, 42, a freelance writer and book author in Raleigh, N.C., fondly recalls how her parents helped her replace a plastic snake prize she lost at age 8 on a bumper car ride. She and her mother rode the ride again in an attempt to find it, but never did. Her father spoke to a kind carnival worker, who let her win another snake.

Reilly, who didn't learn the real story until years later, says the experience thrilled her, and helped her see how other people could help "make a little magic happen for your kid."

Replacing the beloved item

A number of replacement options are now available :

eBay. Look through existing listings or post a note in the "Want It Now" section.

LostMyLovey LLC. Web designer Lisa Oliver, 43, of Austin, Texas, created the site in 2009 after searching for her daughter's favorite purple bunny one too many times. The lost-and-found site also sells ID tags for toys and acts as a middleman for those who don't want to put phone numbers or other identifying information on tags. Today, the site has about 1,000 members and "we have helped many, many people find replacement or backup loveys," she says. "I've seen several situations where someone was desperate for a particular toy and a nice mom said 'Gee, I have this in my toy box and my child doesn't even care about it. I'll mail it to you!' It's a feel-good kind of thing."

Plush Memories, founded by Rosemary and Fred Bouchet of Vincent, Ala. The retired couple started the site in 2005 as a free service for people seeking lost stuffed animals, in tandem with an online plush animal store and an offshoot of their vintage collectible online store. "We consider this to be our Christian ministry," says Rosemary Bouchet, 68. They are assisted by a group they call their "Fabulous Finders," usually toy sellers who check in to see if anyone is seeking toys they have in stock. There are now 161 Fabulous Finders worldwide, and the site has helped 504 people locate lost loveys since 2010, when the Bouchets began keeping track.

Stimulus package a vote away from becoming a law

WASHINGTON – The House voted Friday afternoon to approve the final version of the $787 billion economic stimulus bill by a 246-183 vote, according to CNN reports.

A final Senate vote was expected by Friday evening, leaving the bill awaiting only President Barack Obama's signature to become law. Obama has said he would like to sign the law in a televised ceremony on Monday.

According to CNN, no House Republicans voted in favor of the bill, and seven Democrats voted against it.

The bill will need three Republican votes to pass in the Senate. Maine Sens. Olympia Snowe and Susan Collins and Sen. Arlen Specter from Pennsylvania are expected to support the bill.

The bill is loaded with money for healthcare reform and the advancement of healthcare IT. It includes $19 billion for healthcare IT and more than $100 billion for healthcare measures including funding to help beef up state Medicaid coffers and subsidies to help unemployed workers afford healthcare coverage through COBRA.

"The economic stimulus package represents a significant step forward for the advancement of healthcare in the United States," said Harry Greenspun, chief medical officer for Perot Systems. "These funds should significantly advance patient safety and care while creating good paying jobs in the health IT sector, especially if we can achieve the goal of developing an electronic health record of every American."

Dartmouth Board garners $26M innovation grant

With a $26 million government Health Care Innovation Award in hand, the Dartmouth Board of Trustees will hire Patient Family Activators (PFAs), who will assume roles of patient advocate, assisting the patient with care choices and engaging them in a shared decision-making process.

The project will support and connect 15 High Value Healthcare Collaborative (HVHC) member healthcare systems throughout 16 states, and over the course of three years, will train 5,775 healthcare workers and create 48 new PFA positions.

A portion of the funding will also be used to improve patient data collection via health information technology, as William Weeks, MD, co-creator of the Dartmouth Institute for Health Policy and Clinical Practice, explained.

“Some funds will be used to both facilitate learning and deployment across the HVHC members as well as collecting data (through grant funded tablets that will be integrated into local EHRs), feeding back reports on results, and expanding current IT infrastructure to supplement current HVHC reporting abilities and better integrate such reporting into HVHC member IT systems.”

Health and Human Services (HHS) Secretary Kathleen Sebelius announced on June 15 the second round of recipients for the Health Care Innovation Awards, funded through the Affordable Care Act. The  Dartmouth Board of Trustees was among 81 groups nationwide that walked away with a win.

Three-year cost savings from the Dartmouth project are estimated to be more than $63.7 million, and Weeks explained the majority of savings would result from the overall reduction in Medicare costs of each patient.

Weeks said, “Savings are therefore derived from both improving the efficiency and reducing the costs of each episode of care and using patient shared decision making to help patients make informed decisions, decisions which – according to the literature – are more conservative and less costly than the care that their providers would recommend.”

He continued, “By engaging providers in improving the efficiency and safety of care processes, and by engaging patients in the decision-making process regarding their healthcare choices, we believe that we can reduce this variation and waste, reduce the unrestrained growth in healthcare costs, and concurrently improve patient satisfaction and health outcomes.”

The Dartmouth Board of Trustees-sponsored program was one of 107 total projects nationwide that garnered an Innovation Award out of more than 3,000 applicants nationwide.

The Centers for Medicare & Medicaid Services (CMS) created the Center for Medicare & Medicaid Innovation to improve the health of Medicaid, Medicare and CHIP patients - and by extension all Americans - while combating escalating costs. The $1 Billion Health Care Innovation - carries a triple aim: better health, better healthcare and reduced costs. The Innovation Challenge provides three-year grants of $1 million to $30 million to healthcare providers, payers, local government entities, and public-private partnerships, including collaborative efforts among multiple payers.
 

What's Up, Doc? When Your Doctor Rushes Like The Road Runner

Enlarge iStockphoto.com

Patients continue to complain that physicians don't spend enough time examining and talking with them.

iStockphoto.com

Patients continue to complain that physicians don't spend enough time examining and talking with them.

To physician Larry Shore of My Health Medical Group in San Francisco, it's no surprise that patients give doctors low marks for time and attention.

"There's some data to suggest that the average patient gets to speak for between 12 and 15 seconds before the physician interrupts them," Shore says. "And that makes you feel like the person is not listening."

A doctor's impatience, though, is often driven more by economics than ego. Reimbursement rates for a primary care visit are notoriously low, and Shore laments the need to hustle patients in and out.

 

"When you have that pressure to see three, four, maybe five patients an hour, you can't wait for the exposition of the patient's story. Which is exactly what you should do. But you can't," he says.

A new poll by NPR, the Robert Wood Johnson Foundation and Harvard School of Public Health found about 3 out of 5 patients think their doctors are rushing through exams. That's nearly the exact same number as three decades ago.

NPR's survey asked people the same questions as another poll did back in 1983. We found doctors got better marks on some patient interactions. For example, 64 percent of people said doctors usually explained things well to them, versus 49 percent in 1983. They also are more likely to say doctors are trying to hold down medical costs.

But when it comes to time, there is a stubborn feeling that doctors are in too big of a hurry. That is troubling � and frustrating � to physicians like Shore who feel that they are already packing more into every workday and are stretched thin by paperwork.

"I think a lot of physicians in smaller practice realized they were becoming both the clerk and the HR and the accounts payable and the accounts receivable and the office manager � things which they may not have an interest in and certainly had no training for," Shore says. But he says many doctors just didn't have the cash flow to hire administrative staff.

Two months ago, Shore opened a new office in which he's trying to break from the day-to-day grind. Appointments are now 20 minutes, instead of 15. And he's hired several other doctors to spread the workload around. But there's also been a shift in his thinking about the way he provides care to his patients: He's trying to treat them more like customers, and focus on making them happy.

"Who are your customers? What do they want? Try to meet those needs," Shore says.

And what his customers want, he believes, is access to him and his staff � how they want it, like over email, and when they want it, like after-hours. To do that, Shore has given up on the model of the doctor as a lonely superhero. Instead, everything is about the team.

Shore hunkers down each morning with his medical assistants for a "care huddle," a rare, quiet moment to strategize about the patients coming in that day. Those assistants now play a bigger role in care, renewing prescriptions and briefing the doctor before he enters the exam room. A check-out assistant guides "customers" out the door.

Shore is trying to make up the financial difference of hiring these additional people by getting the office manager to badger insurance companies to pay more money per patient for better patient health.

That doesn't include patients getting any test or treatment they demand. But Shore's younger colleague Payal Bhandari sounds as much a marketer as family physician when she talks about her hopes for a better assembly line.

"It will actually produce a much better product, where you can actually listen to patients," Bhandari says. "And the physician is a lot happier because they don't feel like, 'Ugh! Another person!' They can actually do their job, but there are others helping them in the process."

Will these improvements be enough to move the stubborn poll number? Shore is optimistic, a belief reflected in a fortune cookie message taped to his office window: It says: "Be not afraid of growing slowly. Be afraid only of standing still."

Varney is a reporter with NPR member station KQED.

First lady walks fine line on NYC drink proposal

WASHINGTON(AP)�First lady Michelle Obama says banning big servings of sugary drinks isn't anything she'd want to do at the federal level, but she offered some kind words Tuesday for New York Mayor Michael Bloomberg's effort to do just that. She later issued a statement backing away from taking a stand on New York's controversial proposed ban.

It was a telling example of the fine line the first lady walks as she tries to improve Americans' health and eating habits without provoking complaints that she's part of any "nanny state" telling people how to eat or raise their children.

Asked about Bloomberg's proposal during an interview with The Associated Press, Mrs. Obama said there's no "one-size-fits-all" solution for the country's health challenges. But she said, "We applaud anyone who's stepping up to think about what changes work in their communities. New York is one example."

And asked whether the nation's obesity epidemic warrants taking a more aggressive approach, such as Bloomberg's, she said: "There are people like Mayor Bloomberg who are, and that is perfectly fine."

Mrs. Obama later issued a statement saying that she hadn't intended to weigh in on the Bloomberg plan "one way or the other."

"I was trying to make the point that every community is different and every solution is different and that I applaud local leaders including mayors, business leaders, parents, etc., who are taking this issue seriously and working towards solving this problem."

"But this is not something the administration is pursuing at a federal level and not something I'm specifically endorsing or condemning."

In the interview, Mrs. Obama said she's "trying to create a big tent for people. Our motto is everyone has a role to play in this and I think it's up to communities and families to figure out what role they can play, what role they should play."

Last week, Bloomberg proposed limiting portion sizes of sugary drinks to 16 ounces at the city's restaurants, delis, food trucks, movie theaters and sporting arenas. Regular soda and sports drinks would be affected but not diet sodas.

The proposal is unpopular with most New Yorkers, according to a NY1-Marist poll conducted Sunday. A majority of New York City residents said the proposal was a bad idea and 53 percent said it was more government going too far than good health policy to fight the problem of obesity. The ban is expected to win the approval of the Bloomberg-appointed Board of Health and take effect as early as March.

Mrs. Obama spoke about the Bloomberg plan during an interview promoting her new book, "American Grown: The Story of the White House Kitchen Garden and Gardens Across America." The $30 book, which came out last week, traces the story of the garden on the South Lawn and of gardens around the country as the starting point for a national conversation "about the food we eat, the lives we lead, and how all of that affects our children," as Mrs. Obama puts it.

The first lady, wearing a print dress and periwinkle cardigan, enthused over green peppers coming into their own and a fig plant that's finally standing tall after a perilous infancy as she offered a walking tour of the garden. She ducked under some evergreens to point out a row of logs nailed to a post that will soon be sprouting shitake mushrooms.

Then, seated at a picnic table dressed up with a yellow checkered tablecloth, the first lady spoke of the progress that's been made in offering people healthier food choices and better nutrition information.

Mrs. Obama had just come from an appearance with Disney executives, where the company announced it would become the first major media company to ban junk food ads from its TV channels, radio stations and websites intended for children, starting in 2015.

Later in the day, she was scheduled to present a garden-related Top 10 list on CBS' "Late Show With David Letterman."

An example from her list, according to a CBS preview: "No. 7: In his lifetime, the average American will eat half a radish," she said, speaking from the White House Map Room.

And next Tuesday, she'll do a book signing at a Barnes & Noble in Washington � for a limited number of customers who buy a book this week and get a special wristband.

It's all part of the first lady's all-out effort to combat childhood obesity without provoking a backlash by pushing too hard. Mrs. Obama's high favorability ratings show she's largely been able to strike the right tone, a boon to her husband's re-election effort. But there is still sniping from some on the right who say they don't need a government lecture � or more intrusive steps � on what they eat or how they exercise.

Asked if she ever has to bite her tongue at Obama critics � legion in an election year � the first lady batted away the idea, saying she stays away from "all the chatter and the noise."

"It's not a difficult thing for me to do because we've got so much good stuff to talk about � like this book and the garden and getting our kids healthy and active," she said.

Mrs. Obama spoke of the enthusiastic response the garden has elicited from kids all over the country � but not so much from her own daughters.

"You know, they are not interested in gardening," she said. "I think it has a lot to do with the fact that I'm their mother and this is my interest, and they go in the opposite direction."

Single-Payer Talking Points & Why Mandate Plans Won’t Work

The New York City Chapter of Physicians for a National Health Program has put together some “talking points” for making the single payer “expanded and improved Medicare for All” argument.

1. Americans are afraid that they can�t afford to get sick. Those of us with insurance are paying more and more of the premium and more out of pocket as well. Studies show further that we face bankruptcy if we get sick. Many among us have to choose between paying for medicine and paying for food and housing. And with the recent economic downturn, the ranks of those without insurance are growing.

2. A majority of physicians (59 percent), and an even higher proportion of Americans (62% or more) support single payer national health insurance or “Medicare for all”. In spite of this, all we are hearing about today are mandate plans that would require everyone to buy the same private insurance that is already failing us. These proposals don�t regulate insurance premiums, they don�t keep the insurance companies from refusing to pay many of our bills, and they don�t improve the insurance we now have. Some offer a “public option,” but this will quickly become too expensive as the sick flee to the public sector as private insurers avoid them, abandon them, or make it too difficult for them to get their bills paid.

3. These mandate proposals won�t work, either to expand coverage or to contain costs. Plans like these have been tried in many states over the past two decades (Massachusetts, Tennessee, Washington State, Oregon, Minnesota, Vermont, Maine). They have all failed to reduce the number of uninsured or to contain costs.

4. These mandate plans will add hundreds of billions of dollars to the nation�s health care costs. In this economic downturn, we need assure health care for all without adding to the nation�s cost and the government�s deficit. The bottom line is: these proposals don�t reform the system � they just add to it.

5. As long as we continue to rely on private for-profit insurers, universal coverage will be unaffordable. Their administrative costs consume nearly one-third of our health care dollar. We will never have enough money to provide everyone with decent care until we eliminate private insurance with its enormous waste and inadequate coverage. And we will never be able to keep costs down and get the care we need as long as the wasteful and unnecessary insurance companies stand between us and our doctors.

6. Every other industrialized country has some form of universal health care. None uses profit-making, investor-owned insurance companies like ours to provide health care for all their people.

7. We have an American system that works. It�s Medicare. It�s not perfect, but Americans with Medicare are far happier than those with private insurance. Doctors face fewer hassles in getting paid, and Medicare has been a leader in keeping costs down. We should improve and expand Medicare to cover everyone.

8. A single payer “Medicare for All” System is embodied in H.R. 676, sponsored by Rep. John Conyers and 92 other Members of Congress. It would have:

Automatic enrollment for everyoneComprehensive services covering all medically necessary care and drugsFree choice of doctor and hospital, who remain independent & negotiate their fees and budgets with a public or non-profit agency.Public or non-profit agency processes and pays the bills.Entire system financed through progressive taxes.Help job growth and the entire U.S. economy by removing the burden of health costs from business.Cover everyone without spending any more than we are now.

9. The growth in health care costs must be addressed if any proposal is to succeed.

Single payer offers real tools to contain costs: budgeting, especially for hospitals, planning of capital investments, and an emphasis on primary care and coordination of care.

Mandate plans offer only hopes: competition among insurance companies, computerization, chronic disease management. Competition among the shrinking number of insurance companies has already failed to contain costs and, in the absence of single payer and reformed primary care, computerization and chronic disease management will raise costs, not lower them.

10. Single payer Medicare for All is the right answer:

It is right on choice. It provides free choice of doctor and hospital, the choice Americans want and value. In mandate plans, we lose those choices.

It is right on efficiency. Single payer would slash administrative costs and can promote efficient primary care, management of chronic diseases, and the expanded use of electronic medical records.

It is right on accountability. It will be a public, non-profit system that will respond to what doctors and their patients need, not what corporate executives and their stockholders want.

References by Number:
1. “Illness and Injury as Contributors to Bankruptcy,” D. Himmelstein et al, Health Affairs Web Exclusive, February 2, 2005.

2. Carroll, A., Ackerman, R., “Support for National Health Insurance Among U.S. Physicians: 5 Years Later,” Annals of Internal Medicine, 148(7), April 1, 2008; ABC News/Washington Post, Oct. 9-13, 2003, Associated Press/Yahoo News Poll, Dec. 14-20, 2007.

3. S. Woolhandler, et al “State Health Reform Flatlines,” International Journal of Health Services, 2008; Marcia Angell, “Health Reform You Shouldn�t Believe In,” The American Prospect, April 21, 2008.

5. S. Woolhandler, et al “Costs of Health Care Administration in the U.S. and Canada,” New England Journal of Medicine, Sept. 21, 2003; J.G. Kahn et al, “The Cost of Health Insurance Administration in California: Estimates for Insurers, Physicians, and Hospitals,” Health Affairs, 2005.

6. Reid, T.R., “Sick Around the World,” PBS, April 15, 2008; Thompson, S., Mossialos, E., “Private Health Insurance and Access to Health Care in the European Union,” Euro Observer, Spring 2004.

8. United States National Health Insurance Act (or the Expanded and Improved Medicare for All Act), H.R.676, www.thomas.gov/cgi-bin/query/z?c110:H.R.676 ; “Health Care for All Californians Act: Cost and Economic Impacts Analysis,” The Lewin Group, January 2005

This article is from the Daily Kos.

Axial Exchange acquires Mayo Clinic mobile platform mRemedy

RALEIGH, NC – Axial Exchange Inc. announced Thursday that it has acquired mRemedy, a mobile healthcare platform founded by Mayo Clinic and Minneapolis-based DoApp.

Officials say the acquisition will give Axial Exchange the software, pipeline and customers of the myTality patient-facing mobile healthcare application, which helps patients navigate a future hospital visit, and helps hospitals better market their services. Axial will use the myTality suite as the patient-facing complement to its care transition products, Axial Patient and Axial Provider.

The deal also provides Axial Exchange with access to consumer content from MayoClinic.com. This content will be incorporated into Axial’s current patient-facing products, as well as in future Axial offerings. The health information licensed to Axial includes detailed information on nearly 1,000 conditions and diseases.

Canaan Partners, Axial’s lead venture capital investor, and Mayo Clinic both invested in Axial Exchange to complete the deal, officials say. In addition, four Mayo Clinic physicians will join Axial’s advisory board and bring their expertise to the ongoing development of Axial’s solutions. These include Paul Y. Takahashi, MD, Nathan Jacobson, DO and two others to be named.

“Patients and their families want and expect the most up-to-date information about life, health, disease and treatment,” said Takahashi, associate professor of medicine at Mayo Clinic, an expert in the field of geriatric and internal medicine. “Mayo Clinic’s health information content will now reach even more people, providing accurate answers to common and uncommon health issues.”
 
“This is a case where one plus one definitely equals three,” added Stephen Bloch, MD, general partner at Canaan Partners. “Integrating a patient’s personalized care plan into a hospital’s mobile portal was the logical next step to allow hospitals to offer end-to-end patient care. Having Mayo Clinic on the Axial Advisory Board will augment our philosophy of offering the gold standard in patient engagement.”

Axial’s solutions won first prize in the U.S. Department of Health and Human Services’ Partnership for Patients Initiative innovation competition, run by Office of the National Coordinator’s (ONC), on “Ensuring Safe Transitions From Hospital to Home.”

The myTality acquisition will accelerate the firm's move into mobile healthcare and will enable Axial to more quickly scale to large numbers of mobile patient-customers – while interconnecting patient’s care plans and discharge information, and providing added patient engagement in the goal of reducing readmissions, officials say.
 
Axial Provider provides an at-a-glance clinical dashboard to connect hospitals, physicians, and health plans – automatically updating and sharing details about ER and inpatient encounters, and specialist test results. Axial Patient then delivers relevant information to patients and caregivers on their tablets, laptop and mobile phones. This better facilitates a safe patient transfer and helps the entire healthcare system to better manage treatment.

She added that, with 20 percent of patients discharged from the hospital being readmitted within 30 days, "our nation has lots of room for improvement. We owe it to patients and the professional healthcare community to start harnessing technology that can help them.”

A puzzled Canadian ponders surreal U.S. health-care debate

Why are Americans distorting the reality of Canada’s most prized social program?

Earlier this year, before the political battle over health-care reform in the U.S. reached its current fever pitch, I was in Tuscaloosa answering questions from University of Alabama business students.

They were interested in my views, as a Canadian and as a former insurance company executive, about what they had been told about the Canadian health-care system.

My impression was that much of what they had heard had been the sort of right-wing, special interest nonsense that has subsequently characterized the health-care reform debate in the United States.

I told them that Canadians value their single-payer government health-care system so strongly that any change that appears to pose a threat to it is the third rail of Canadian politics; that most Canadians value the system’s quality of care; and that although many do still complain about wait times to see specialists in certain fields, government has moved to address this issue in recent years. By April of this year, at least 75 per cent of patients in Canada were receiving non-emergency surgeries within appropriate wait-time benchmarks.

If asked to single out an aspect of Canadian society superior to that of our American neighbours, most Canadians would cite first our health-care system. What I also might have mentioned were aspects of the American health-care debate that Canadians find puzzling, if not downright perverse. These include:

* The use of wildly misleading references to wait times in Canada even though 47 million Americans have no health insurance and, therefore, are forced to line up for treatment in hospital emergency rooms, to say nothing of the thousands who queue in parking lots across the U.S. to receive free treatment periodically provided by “Remote Area Medical” volunteers.

* U.S. opinion polls that show 77 per cent of Americans are generally satisfied with their health care when so many millions of their fellow citizens are uninsured and many millions more under-insured; when three-quarters of the families filing for illness-related bankruptcy actually have health insurance; and when insurance premiums have grown three times faster than wages between 2000 and 2008.

* The negative representation of Canadians’ experience with “socialized medicine.” That portrayal is at odds with reality. For example: 85 per cent of Canadians have their own primary care physician and 92 per cent would recommend that doctor to a relative or friend; 95 per cent of Canadians with chronic conditions have a regular place of care; of those requiring ongoing medical care most were able to see a doctor within seven days.

* The widespread use of an exceptional and misleading Canadian case. It involves a television commercial featuring an Ontario woman, who (American viewers are told) had to go to the U.S. to have a life-threatening brain tumour removed in order to save her life. Why? Because of a six-month wait time in Canada for treatment. The patient has since admitted to a three-month wait time involving a diagnosed benign Rathkes cleft cyst, the removal of which at a Mayo Clinic in Arizona cost her $97,000 that she is now seeking to recover from the province where its removal would have cost her nothing.

* The fact that a huge contributor to the rapidly rising cost of U.S. health care is the central involvement of insurance companies. They add significant cost due to both administrative complication and inefficiency as well as the pursuit of profit. Canada constructed a health-care “insurance” system from which insurance companies were excluded in favour of single-payer, state-financed insurance. Thoughtful Americans understand that insurance companies are needed for an efficient, patient-oriented health-care system as much as a fish needs a bicycle. Minimizing the payment of health claims by insurance companies is, for executives interested in their compensation and their careers, what the companies’ role in health care is all about.

* President Barack Obama will address a joint session of Congress tonight in a bid to revive his faltering health-care initiative. From a Canadian perspective, the U.S. debate seems to have been shaped by the unfortunate conjunction of several factors:

* A political system that continues to be captive to special interests like insurance and Big Pharma companies, which spend millions of dollars annually lobbying against even small steps toward reform.

* A credulous American public, many of whom seem prepared to believe what appears to most Canadians as laughable propaganda from the right against any hint of advantage to be derived by patients from a public health-care system.

* The absence of impact on so many members of Congress of indisputable facts, including higher American spending on health care as a proportion of GDP (nearly 17 per cent) than any other OECD country government (in Canada it is 10 per cent), without securing the best health outcomes for its citizens. According to the World Health Organization, the United States spends 23 per cent more per capita on health care than Canada does.

* The fact that advocates of what to most Canadians is the best and only serious option � a single-payer system similar to the existing U.S. medicare system for the elderly and disabled � not only have not been given a decent seat at the table in this debate but have been deliberately excluded from any genuine participation by politicians of both parties.

The current U.S. health-care system and the opposition to meaningful and desperately needed reform strikes me (and I think I have lots of company among Canadians) as being as bizarre as American gun laws.

The latter likely is the second biggest difference most Canadians would cite between their society and that of their neighbours.

Alastair Rickard is a former executive with Mutual Life, Clarica Life and Sun Life and was the founding editor of the Canadian Journal of Life Insurance. He blogs at RickardsRead.com.

Allscripts shores up board, HealthCor drops lawsuit

CHICAGO – In an agreement with one of its largest shareholders, beleaguered EHR vendor Allscripts (NASDAQ: MDRX), plans to shore up its board of directors with three new independent members. As a result, investor HealthCor will drop its lawsuit against the technology company.

Nominated to the Allscripts board are Stuart L. Bascomb, David D. Stevens and Randy Thurman. Elections are set for the 2012 annual meeting of stockholders scheduled for June 15. Each nominee has previously served on the boards of directors of public companies and private organizations.

[See also: Web First: Q&A with Allscripts CEO Glen Tullman]

HealthCor, which had previously called for CEO Glen Tullman’s resignation, owns approximately 6.1 percent of the outstanding shares of Allscripts’ common stock.

Tullman said in a news release today the new members would “bring new perspectives and additional industry experience to our board.”

“Taken together with the recent additions of Paul Black and Robert Cindrich, the company will have added five, high-quality, independent directors in just the past few weeks,” Tullman added. “We believe this is a positive outcome for Allscripts and its stockholders and we look forward to working collaboratively as we continue to implement our strategic initiatives and make the important and necessary investments to deliver a connected community of health for our clients and build value for all of our stockholders.”

[See also: Allscripts: Debacle or silver lining?]

“We are pleased to have reached this amicable resolution with Allscripts, which we believe will serve the best interests of all stockholders,” said Arthur B. Cohen, co-founder and portfolio manager of HealthCor. “We continue to believe that Allscripts has great products, strong capabilities and a unique installed base of customers. Furthermore, we are confident that Stuart, David and Randy will make strong additions to the board, and will work hard to represent all stockholders and assist the company in seizing the tremendous market opportunity before it.”

Bascomb currently serves as the chairman and CEO of QualSight, a startup company in Chicago that aims to create a nationwide network of ophthalmologists to market a managed care refractive surgery program to plan sponsors. Bascomb was a founder of Express scripts in 1986 and helped lead its IPO in 1992 as the company’s CFO.

Stevens is involved as an investor and adviser in private equity, focusing on providing capital to lower-middle market growth companies in the healthcare services industry. Previously, he served as CEO of AHG Division of Medco Health Solutions, Inc., where he was responsible, as the previous chairman and CEO of Accredo Health Group, which was acquired by Medco, for the strategic direction and operation of the consolidated specialty pharmacy division of Medco (a reporting division of the parent), the largest specialty pharmacy provider in the market.

Thurman serves as the senior advisor and operating partner at New Mountain Capital LLC, a private and public equity firm with assets of more than $10 billion. He has led or co-led transactions representing more than $1 billion in enterprise value, and advised on private equity, public equity and debt transactions.  Mr. Thurman has held a number of executive positions throughout his career, including founder, chairman and CEO of Viasys Healthcare.

In addition to the three new independent nominees, the company’s nine-member slate for election at the 2012 annual meeting will consist of: Paul Black, Dennis Chookaszian, Robert Cindrich, Philip Green, Michael Kluger and Glen Tullman. Of the nine board members, eight are independent.

Allscripts troubles came to light at the end of April, and may have begun in 2010 with the Allcripts-Eclipsys merger. Allscripts stock plummedted by more than 40 percent on April 26 after it reported disappointing first-quarter results and announced it had fired its chairman, Phil Pead, who came to Allscripts as part of the Allscripts-Eclipsys merger. Three board members resigned in protest. Tullman and Allscripts customers have agreed that a big piece of the company’s trouble had to do with its failure to integrate the Allscripts/Eclipsys products.

[See also: Allscripts in skid mode as shares plunge, chairman ousted]

6 opportunities to keep hospital supply chain in line

This past March, Texas Children's Hospital in Houston opened its Texas Children's Hospital Pavilion for Women after recently expanding a new West Campus in an effort to meet growing needs and a shift in population base. And with this growth, said Rick McFee, director of supply chain management at Texas Children's, there came an excellent opportunity to streamline the system's supply chain.

"Due to both of those projects as new projects, we had the ability to look at supply chain and how we were managing all that activity," he said. "It gave us the opportunity to look at new ways of doing that."

[See also: Premier's supply chain program boosts bottom line]

McFee, based on his experiences, outlines six keys to supply chain management. 

1. IT systems should support maximum flexibility. When deciding on an IT system, said McFee, the organization chose to look, first and foremost, for one that gave them maximum flexibility. "We were making sure we could manage multiple types of items," he said. "For example, not every item can fit into the same box or container, so we needed to make sure we had maximum flexibility." Having a close-cabinet system, he added, results in more limitations than an open-cabinet system, putting the emphasis on barcoding to streamline processes. "So as long as you can grab that item and scan its barcode, or have the barcode label close to the item's location, the system works," he said. "That was one of the things we were looking for: the flexibility to manage multiple different types and sizes of projects without limitations to the physical constraint."

[See also: VA deploys robotic systems across healthcare facilities]

2. Try to manage utilization at the floor level. Within Texas Children's facilities, said McFee, a nurse can pick up an item and see barcoding from both the manufacturer and the facility itself, allowing them to scan either code and document the inventory. "From a nursing perspective, they can scan it when they're pulling it off the shelf, or when they have it in their hand," said McFee. "In all of these systems that we used, the key concept is to try to manage the utilization at the floor level to the point where the user – the nurse, the technician, whoever – is basically documenting their use of that item." And, in the background, McFee continued, the system manages the generation of, say, a replenishment request automatically, "without someone having to go up and count every shelf," he said.

3. Include nurses on compliance efforts. McFee said they both train and monitor nurses on their compliance efforts, while identifying folks who may be having issues maintaining compliance. "We're talking down to the individual level or groups of folks," he said. "So if we find an item that's consistently not being captured, we work with nursing on how we can improve that, and how [we] can handle [this] in a different way." McFee added nurses also took a hard look at their own utilization patterns, which allowed the organization to dramatically reduce numbers when shifting to a new system. "We reduced the numbers for what [nurses] thought they'd be using," he said. "In some cases, they had a 10- to 12-day supply sitting on the shelves, and they were down to three to five a day for most items. That was a dramatic reduction."

4. Be aware of utilization patterns. An advantage of using a system to help streamline supply chain efforts is having the ability to key in your "true utilization patterns," he said. "All of these systems manage those utilization numbers, and they allow you to tweak those numbers to fit the true utilization patterns," he said. Communication with nurses and this function, McFee said, played a large part in the overall reduction in the inventory sitting on the floor. "That was through a multiple step process," he said. "We went through to right-size our inventory for the right volume of activity they were expecting."

5. Review your standardization and have a strong value analysis process. This is an "old stand-by" point, said McFee, and includes making sure you don't duplicate products in your supply chains. "And that means a pretty robust value analysis process, and one that's looking for opportunities, especially where we may be using a different manufacturer for achieving the same functional requirements," he said.  "It's also looking at what you can do to reduce those number of overall lines." The value analysis process, he added, should look at any addition to the supply chain from a value perspective, while comparing it to what an organization currently has in stock. "We're always looking to use the best, most efficient and most effective product," he said. "[For example,] if you have a product and you're getting a great price on it, but in reality, you're using two or three of them when one should be working – finding these issues and those items and working closely with the clinical staff to identify those opportunities for change. It's part of what our value analysis does."

6. Don't forget about the data. Lastly, said McFee, you can't forget about the data. "Data, data, data," he said. "If you're not tracking it and you don't have your utilization activity through your ERP system or your point-of-sales system, you need that utilization data on everything." He added that purchasing systems should be linked to a point-of-sales system, allowing for a "single item master," he said. "So if someone goes to order something, if it's an item that's already out there, we may prevent them from creating a PO if they could get it from our warehouse," he said. "Or, we may have a contract established for an item with a vendor. We may not stock it, but the pricing has been established, which cuts out a significant amount of time within our purchasing function."

“I Prefer Single-Payer, But …. “

The Selling of Single-Payer Features

�Start off on high ground but end up somehow crawling��
–Bruce Springsteen, The Big Muddy

The farce in Washington DC called health care reform makes the blood of single-payer supporters boil. That the Obama administration has crafted and is trying to push through an unfathomable, over one-thousand page piece of shit legislation that in no way ends the health care crisis, and in fact, strengthens the power and position of the private insurance industry, should not be surprising. Obama sold out on the single-payer solution the moment he decided to run for the presidency and accepted campaign contributions from both the insurance and pharmaceutical industry.

That the voice of single-payer (SP) has been blacked out nationally (documented by Fairness and Accuracy in Reporting) also makes our blood boil. It�s as if our movement doesn�t exist. But it does. There are hundreds of grassroots SP organizations all across the country engaging in public activism and protest, we just don�t get press.

Only John Conyers single-payer legislation, HR 676, The United States National Health Care Act, fundamentally restructures health care, guarantees it to the entire population (the undocumented, too) and is fully funded. No other piece of legislation is as comprehensive. How many Americans know about this amazing, life-transforming bill that delinks employment from insurance and abolishes the despised health insurance industry? Has there been a front page story or major magazine interview with Congressman Conyers? There�s been virtually no stories about labor�s support for HR 676, despite the fact it�s been endorsed by 554 union organizations in 49 states and by 130 Central Labor Councils. But we heard plenty when Andy Stern, the president of the SEIU sat down with Lee Scott, the CEO of Wal-mart to discuss solutions to the nation�s health care crisis. Those two are experts on providing health care to workers? What about the nurses and doctors who support single-payer and got dragged out of, and arrested in Max Baucus�s senate hearings in Washington, DC? If doctors and nurses had been arrested for any other political issue it would have been the lead story in every newspaper and online edition. Doctors and nurses never deliberately get arrested — that�s news!

The sea change in the public�s attitude toward government financed health care, however, has gotten press. A New York Times poll in June found that 72 percent supported a government-administered insurance plan � like Medicare for everyone under the age of 65. That poll also reported 64 percent believed the federal government should guarantee coverage to the entire population, i.e. health care should be a human right. Another interesting number: 85 percent of respondents said the health care system needed to be fundamentally changed or completely rebuilt. This is in stark contrast to President Obama�s position of tepid, incremental reform. Obama asserts if he was starting from scratch he might favor SP, but we aren�t so he can�t. He wants to build on the existing system and not �disrupt� the employment-based provision of health care. As if employment-based health coverage isn�t being massively �disrupted� by the economic depression that has laid off millions of workers and forced them down into the ranks of the 50 million uninsured.

But what is truly disgusting is how the �progressive� left has caved so quickly and cravenly, given up the fight for single-payer and support for HR 676. They have become the indignant foot soldiers, apologists and spinmeisters for Obama�s piece of shit legislation. They are betraying what they absolutely know to be true: the private insurance industry must be evicted in order to provide health care to everyone and end the fiscal crisis the multiple-payer system creates. Even the insurance companies know that according to revelations by Cigna whistleblower Wendell Potter. He reports the implementation of a single-payer health care system is what keeps the billionaire CEO�s of insurance companies and Karen Ignagni, the high priestess of America�s Health Insurance Plans (AHIP), awake at night cowering in fear and forced to spend 1.4 million dollars a day to make sure it doesn�t happen. They don�t fear a public option despite their protestations; they accept that due to the depth of the crisis, a few token compromises are in order to stay in business. It�s chump change and in exchange for perhaps losing a little market share, they�re going to get a mandate that legally obligates every person to buy their priced-to-make-profits �insurance products� or be financially penalized. If the Obama bill subsidizes the uninsured going into private plans, that�s millions of new customers to extract profits from and a transfer of taxpayer dollars into insurance industry coffers. The Massachusetts mandate madness gone nationwide.

First the �progressive� Democratic Caucus jumped the single-payer ship arguing without even launching a fight that HR 676 was not �politically viable.� A senior research associate with Physicians for a National Health Program (PNHP) told the following story. He gave testimony to the caucus on why the public option was flawed and to continue robust support for HR 676. He was appalled to learn staffers for caucus members were claiming the public option was the same as single-payer or would lead to single-payer. The staffers banned him from handing out information comparing the public option to single-payer. They tried to censor his speech but he gave it anyway. When members of the caucus asked questions staffers continually interrupted him.

Health Care for American (HCAN), Katrina Vanden Heuvel of The Nation, Robert Reich, Joshua Holland of Alternet, and a raft of other progressive political pundits are pumping out article after article attempting to explain away or marginalize the myriad problems with the public option: the gaps in coverage, the millions that will be left uninsured, and how to fund it so that it�s �deficit neutral.�

They often begin by declaring, �I�d prefer a single-payer system but�� But what?

Joshua Holland�s article titled, �We Need Clear Thinking: There Should Be No Clash Between Public Option and Single-Payer,� is the most recent and best example of giving up and selling out single-payer. He too confesses in the piece (three times!) he really is an advocate of single-payer, but � But what? Holland argues, �The public insurance/single-payer rift is a false dichotomy and is distracting us from the real fight.� Dead wrong. The so-called public option and SP as embodied in HR 676 stand in direct opposition to one another. The �real fight� is to pass HR 676. The �distraction� is the public option. Holland then goes on to undercut his argument even further by maintaining, �The proposal before us today, if done right – and the devil is most certainly in the details � achieve a hybrid public-private system with �some single-payer features�� Huh? We already have that system, it�s not working. Holland thinks eventually the public option will �achieve something approaching a single-payer system � through the back door.� I�m gobsmacked by Joshua�s naivet� or is it stupidity? Single-payer health care systems always come in through the front door. They don�t evolve into existence over time.

Secretary of Health and Human Services Kathleen Sebelius was asked about the public option, �Can you say flat out that it�s just never going to be single-payer health insurance?� She replied, �Oh, I think that�s very much the case.� She then went on to make the case which I won�t repeat here. When President Obama addressed the American Medical Association (AMA) he asserted, �What are not legitimate concerns are those being put forward that claim a public option is somehow a Trojan horse for a single-payer system�So when you hear the naysayers claim that I�m trying to bring about government-run health care, know this � they�re not telling the truth.�
We would do well to believe Obama and his fellow Democrats when they straight up tell us they are opposed to single-payer.

But Holland�s noxious line of reasoning goes even further. He posits the false notion that single-payer systems don�t really exist in other countries, but instead are �multiple-payers but with some single-payer features.� He cites Germany, Holland, Belgium and France as examples. This is simply not true. Elimination of U.S.-style private insurance, if it existed in the first place, has been a prerequisite to implementing a universal health care system in every country that has socialized health care. In each country the government guarantees coverage and pays for the majority of it, even though it might be privately delivered. Moreover, in none of these countries does the private insurance industry have the power, profits or influence they do in the United States. In some, they are allowed to feed around the edges of the system which can lead to problems. Ireland is an example. The private health insurer BUPA recently left the Irish market after a judge determined the company had unfairly skimmed healthier patients from the public system and ordered the company to make adjustment payments. Can you imagine that ever happening in the United States?

Holland thinks progressives need to �refocus the debate toward how much private sector involvement we want, what structure we might adopt for health care financed through the private sector in order to keep the insurance industry�s predations in check.� He acts as if all sides in the health care debate were sitting down as equals and had equal input. Progressive don�t even have a seat at the damn table. Holland sounds like Obama who tells us we have to keep the insurance companies �honest.�

This is a debate over fundamentals and ideology, not tactics on how to get to a single-payer system, despite Holland�s insistence it�s the other way round. Single-payer supporters aren�t fighting for a health care system designed to keep corporate killers predations in check, ensuring their honesty or �fair competition.� Why would anyone want to do that? Our movement is fighting to get rid of an industry that puts profits over patients once and for all and we have the audacity to believe we can do it.

We haven�t given up and we haven�t sold out.

It�s both better and honest to stand up and get arrested fighting for a piece of legislation you know will end unnecessary death and human suffering than to crawl and �advocate fiercely� as Holland is for a piece of shit legislation he knows will not.

Helen Redmond is a member of Chicago Single-Payer Action Network (CSPAN) and a licensed clinical social worker at Cook County Hospital and Clinics. She can be reached at: redmondmadrid@yahoo.com

Douglas, Patrick co-host health care forum

By Anya Huneke for NECN.com–

48 million Americans. That’s the latest estimate of how many Americans are living without health insurance. President Obama has promised to reduce that number by expanding health care coverage in the U.S. Key players in the reform debate met to do some brainstorming in Burlington, Vermont, today.

Two hours before the forum began, a crowd from all over New England gathered outside the Davis Center at the University of Vermont, seizing an opportunity to send the White House a message about health care.

The event was organized by the Obama administration, hosted by Vermont Governor Jim Douglas and Massachusetts Governor Deval Patrick, and intended to create conversation about health care reform.

This is the second of five White House regional forums on health reform. The first was in Michigan and there are three more to come in California, Iowa, and North Carolina in late March and April.

Douglas and Patrick touted steps taken in recent years to bring coverage to 92% of Vermont and 97% of Massachusetts residents, making these two states, they say, models for the rest of the nation.

White House Office of Health Reform Director Nancy-Ann Deparle says what she heard was urgency, and widespread concern about affordability and accessibility.

Deparle says health care reform is a fiscal imperative that will not be easy and may not be perfect, but is essential in turning this country around.

No 'bubble' for healthcare IT, analysts say

NASHVILLE, TN – Leading financial analysts scoffed at the notion of a healthcare IT “bubble” that could slow the pace of mergers and acquisitions this year. Speaking on a panel called “Financing The Deal” at the Nashville Health Care Council, they predicted that 2012 M&A activity would be brisk, though not superheated.

In the health IT sector, there’s currently a glut of buyers and not enough companies to acquire. There are many non-healthcare players like Lockheed-Martin wanting to buy healthcare IT companies – and many suitors for a limited number of clinical decision support companies. “There are still a lot of great opportunities for technology-enabled healthcare companies with a demonstrable ROI,” said David Jahns, managing partner at Galen Partners.

[See also: All in a week's work]

The analysts agreed that deal-making this year won’t be dampened by uncertainty surrounding the future of healthcare reform. If anything, there’s greater pressure to make deals this year in advance of possible post-election efforts at tax reform.

“There’s still a stable financing environment despite the upcoming election and the events in Europe,” said Jon Santemma, global co-head of healthcare investment banking at Jefferies & Company. “Valuations are down in some sectors like nursing homes and home health, which makes them good deal-making opportunities this year. And we anticipate a lot of deals this year involving private-pay companies.”

There’s still about $350 billion in private equity “overhang”, which sets the stage for some rapid-fire M&A this year. “I look for a lot of activity in the mid-market private equity arena, with a lot of possible deals in the $200 million to $800 million range,” added Santemma.

[See also: Health IT M&A activity down in 2011, value up]

According to Irving Levin & Associates, hospital M&A reached a 10-year high last year, when 86 deals were completed. “I look for hospital transactions to increase,” said Ravi Sachdev, managing director at J.P. Morgan. “The attitude we’re now seeing is, ‘If I can’t be No. 1 or No., 2 in my service area, I want out’.”

Panelists were reluctant to make long-range forecasts. “Five years ago, who would have predicted that you’d have payers acquiring HIEs?” said Jahns. “But that’s exactly what’s happening now.” The panel members agreed that one long-term trend is rock-solid: a lot of money will continue to flow through America’s healthcare system – enough money to allay dealmakers’ concerns about declining state and federal reimbursements.

As for overseas deals, look for increased activity in telemedicine in 2012. China and India have been quick to harness the potential of telemedicine. And as one panelist quipped, “It’s easier for U.S. telemedicine companies to operate in China than across state lines.”

MAP offers HHS recommendations on quality reporting programs

WASHINGTON – The Measure Applications Partnership (MAP) has issued two new reports to the Department of Health and Human Services, presenting quality measurement strategies for hospitals that specialize in cancer care and for hospice and palliative care providers.

MAP is a multi-stakeholder public-private group convened in 2011 by the National Quality Forum (NQF) to provide guidance on measures for use in public reporting, performance-based payment and other performance measurement programs. These two reports are the latest in a series of several quality measurement coordination strategies authored by the group, officials say.

The recommendations in both areas are spurred by new legal requirements. With regard to hospice and palliative care, the Patient Protection and Affordable Care Act (ACA) creates the Medicare Hospice Quality Measurement Program, which requires hospice programs to publicly report quality data beginning in 2014 or incur a financial penalty. Hospice care is a Medicare benefit in the last six months of life.

Likewise, the ACA stipulates that 11 hospitals that specialize in cancer care, called PPS-Exempt Cancer Hospitals, must begin to publicly report quality data in 2014, although with no financial penalty or incentive attached to the reporting activity. These specialty cancer hospitals have been exempt from the Medicare Prospective Payment System (PPS) because their narrow focus on cancer care does not lend itself to the payment program as designed. As a result, they have not been required to participate in federal quality reporting programs that now apply to most other hospitals.

"These measurement strategies are geared toward improving the care of patients grappling with serious and complex healthcare issues," says Elizabeth McGlynn, co-chair of the MAP coordinating committee. "The new public reporting programs, and MAP's reports, are part of a broader effort to ensure that measurement-driven quality improvement and accountability are being applied across the spectrum of the healthcare system."

Both new reports emphasize the importance of measuring components of care that patients and their families find meaningful. This includes surveying patients about their experiences of care, assessing quality of life, evaluating pain and symptom management, and tracking whether each patient has a care plan that signals their preferences, is kept updated, and is being honored. Patients seeking hospice care at the end of life, for example, often choose to avoid unwanted medical procedures and trips to the hospital. Targeted measures can and should assess these dimensions of care, MAP recommends.

The reports also emphasize the importance of measuring how well patients transition from one care setting or type of provider to another – for example, from a hospital to a nursing home or care provided in their own homes. Such "hand-offs" occur frequently for cancer and seriously ill patients and often expose patients and their families to fragmented care from providers who are not communicating – at all or well – with each other. In both new reports, MAP emphasizes that performance measures should evaluate patients' full experiences as they move through the healthcare system, as treatment received in one setting may impact the course of treatment received in another.

"These reports represent an important step toward ensuring that patients who are seriously or terminally ill receive care that addresses all their needs and is being carefully evaluated through standardized measurement programs," says Carol Raphael, chair of the MAP post-acute care/long-term care workgroup.

In each new report, MAP identifies a "core set" of specific quality measures it believes can be applied immediately or quickly adopted to care at PPS-exempt cancer hospitals or to hospice and palliative care services. In addition, the group notes significant areas where no or few measures exist, signaling opportunities for the measure development community to step in to fill important gaps.

In its recommendations for cancer care, for example, MAP stresses the importance of survival data to patients' decision-making on both treatments and providers. It advises that survival data presented to patients and families include information on the specific type and stage of cancer.

"Clear and comparable information on survival rates can be critical to cancer patients and their families making very tough choices at an emotional time," says Frank Opelka, MD, chair of the MAP Hospital Workgroup.

In its report on hospice and palliative care services, MAP notes that many who qualify for the Medicare hospice care benefit either fail to make use of it or do so for a shorter period than the Medicare benefit allows. As a result, MAP advises measuring the degree to which patients have access to, and are well informed about, the alternatives of hospice and palliative care.

"Consistent with its past work, MAP's new reports further expand our thinking about what's important to measure and improve in healthcare in addition to the actual clinical outcomes of care," says George Isham, MD, co-chair of the MAP coordinating committee. "We need to be especially vigilant about how fully and well informed patients are as they move through a complex system, especially if they have life-threatening illnesses or are terminally ill."

The full Performance Measurement Coordination Strategy for PPS-Exempt Cancer Hospitals and Performance Measurement Coordination Strategy for Hospice and Palliative Care reports are available here.