by Mary Ellen Schneider

Earlier today, during a press conference in San Diego, a group of physicians from the Department of Veterans Affairs and Kaiser Permanente announced that they have been successfully sharing electronic patient data between their two systems. The effort is part of a pilot program that aims to turn the exchange of patient data from a weeks-long paper process into something that can be done electronically in a matter of seconds.

At first glance, most patients probably won’t see the big deal. It seems like a good idea if all their doctors know the medications they are on, even if those doctors are working in different institutions. The reality is that simple information such as a problem list, medications, and allergies rarely make it to all the physicians involved in a patient’s care. The officials involved in the pilot were quick to point out the significance. Dr. Stephen Ondra, a senior policy advisor for health affairs and a neurosurgeon at the VA, called today’s announcement the most exciting moment in his medical career—and to put that in context he added that he considers neurosurgery very exciting.

Right now, this is just a pilot and involves only veterans who receive their health care at both the VA in San Diego and Kaiser Permanente. To be a part of the pilot, patients had to opt-in at both locations. But in the future, VA officials want to expand opportunity this to veterans around the country by partnering with other health systems. This kind of information sharing is especially important for veterans, Dr. Ondra said, because three out of four veterans also receive some care in the private sector. Without a standard system for gathering that information, it can fall through the cracks.

It’s easy to see how if this is successfully expanded throughout the country and beyond the VA, it could have the potential to improve patient safety and quality of care. The real question is how long will it take for this type of information exchange to make its way to patients who receive care outside of large, integrated systems like the VA, the Department of Defense, and Kaiser Permanente.

Read more of Mary Ellen at EGMN

As one year ends and another begins, all eyes remain on Congress and the two health bills that will shape the U.S. health system in 2010 and beyond. The American Medical Association has been a regular presence in the health reform debate and has outlined a set of guiding principles for health system reform that will benefit patients and physicians.

"Health care reform has been a major focal point for the AMA and Congress for most of this year, and as the year draws to a close we are closer than ever to achieving health care legislation that will benefit all Americans," says AMA President Dr. J. James Rohack. "We need reform that builds on what works in our system and fixes what doesn't, and we are committed to staying involved in the process to improve the final legislation for patients and physicians."

What should be included in health system reform?

Expanded health insurance coverage for all Americans

Why this is important: The uninsured live sicker and die younger than those with health insurance. Fearing big medical bills, they often delay care so an illness that could have been easily treated early on becomes more difficult and costly to treat. Increasing health insurance coverage can lead to more preventive care, better disease management and healthier Americans.

Insurance market reforms

Why this is important: In the last 10 years, family premiums for health insurance have increased 131 percent. Americans need more choices of affordable health insurance coverage that can't be lost because of job loss or denied based on pre-existing conditions.

Protection of the patient-physician relationship

Why this is important: The patient-physician relationship is the cornerstone of quality health care. Reform efforts must assure that medical decisions and health care choices remain in the hands of patients and their physicians, and are not dictated by insurers or government bureaucrats.

Investment in quality improvement efforts

Why this is important: Optimizing the safety and quality of health care for America's patients is an essential component to true health system reform. By making investments in quality improvement efforts that eliminate problems in the system and promote best practices in medicine, physicians can ensure patients are receiving the best care possible.

Increased focus on prevention and wellness

Why this is important: Seven out of 10 Americans are living with a chronic condition and the cost of treating these conditions accounts for nearly 75 percent of our nation's overall health care spending. Getting regular, preventive care and living a healthier lifestyle greatly reduces the risk for chronic diseases and allows for conditions to be identified and treated early.

Repeal of the broken Medicare physician payment formula

Why this is important: Each year this flawed payment formula threatens steep cuts to physicians for the care of seniors and military families. With the baby boomers aging into the Medicare program in just two years, a permanent solution is imperative to protect access to care for the millions who rely on Medicare and TRICARE now and those that will in the future.

Medical liability reforms

Why this is important: Our country's broken medical liability system forces many physicians to order unnecessary tests, scans, consultations and even hospitalization to protect against malpractice suits. Known as defensive medicine, these practices cost our system an estimated $70 billion to $126 billion and drive a wedge between patients and physicians. Medical liability reforms can help curb health care costs and keep physicians practicing solid evidence-based medicine.

Eliminate waste in the claims process

Why this is important: Administrative burdens weigh down physician offices, adding unnecessary costs and taking away time from patient care. The insurance claims process must be streamlined and standardized so physicians can spend their time doing what they do best - caring for patients.

"A new year can symbolize a new beginning, and in 2010 the AMA is looking forward to a new and improved health system that better serves patients and empowers physicians to deliver the highest quality care," says Dr. Rohack. To learn more about the American Medical Association and its efforts in support of health care reform, visit www.hsreform.org.

Metro Group Inc. in no way supports any particular political view point. "Health Care blog" is a forum where both sides of the issue can state their point of view and make their case for their positions on the very important issue of Health Care Reform in the U.S.

Originally posted by Andrew Coates MD

As you may know, the Federation of Associations for the Defense of Public Health (FADSP) is an organization of Spanish health professionals which for more than 25 years has sought to protect and improve our national health system, of which we have reason to be proud.

Through educational programs and other activities, the FADSP strives to strengthen and safeguard our integral and comprehensive public health system. We advocate sound public health policy and the effective practice of primary care, specialist care and hospital care; the use of all kinds of modern diagnostic, therapeutic and surgical procedures; and the provision of rehabilitation services for the benefit of all of our citizens, regardless of their level of income, their profession, cultural level or regional origin.

This does not mean that our system is perfect, of course, or that it lacks important areas for improvement. But its achievements are many and it is highly cost-effective: our country dedicates only 6 percent of our GDP to keep the system running.

Our health system is basically free at the time of use, except for a prescription co-payment of 40 percent. The co-payment is waived for seniors.

The funds for financing the system come from taxes, particularly income taxes, so the burden on each individual depends on their income level. This allows the wealthy to show solidarity with the weak, those who have jobs to express solidarity with those who are unemployed, the younger to help the older, and those who enjoy good health to assist the sick.

Read the rest of the article at Physicians for a National Health Program

DISCLAIMER: Dr. Vliet speaks as an independent physician, not as an official spokesperson for any organization, including Metro Group, Inc. Dr. Vliet has no financial ties to any health care system, pharmaceutical company, or health insurance plan. Her allegiance and advocacy is to and for patients.

By: Dr. Elizabeth Lee Vliet

I am shocked and appalled at the cataclysmic shift in the guidelines to later age and less frequent mammograms. This is diametrically opposite from the American Cancer Society guidelines, and from what most oncologists and practicing physicians think is needed.

Fundamentally, I do not agree with delaying mammograms to age 50, or reducing screening to every two years, or stopping mammograms at age 74. I think these new guidelines are detrimental to our goals of getting early detection and prompt treatment for women with breast cancer.

Even more ominous, the recommendation to start mammograms at age 50 instead of age 40 comes at a time when physicians are seeing younger women developing breast cancer. It makes no sense to me as a women’s health physician to suddenly decide to wait until an older age to screen for breast cancer when we know that survival is improved the earlier the diagnosis is made and treatment is begun.

It makes no sense, that is, unless you realize that this change is primarily designed to cut costs, not improve women’s health. I think this is just the start of government-mandated guideline-based rationing of healthcare. As has been the case my whole career, I see that women are the first group to suffer when cost cutting takes precedent over sound medical care.


Poor women, who depend on Medicaid or Medicare coverage, will be hurt most of all since they are less likely to have the resources to get mammograms if government insurance has decided to cut back and pay for mammograms less often, or limit payment for the test based on age.

This is exactly what has been going on with the government-controlled health service in Britain! Due to cost cutting, British women can only get NHS coverage for mammograms every three years from age 50 to 70. What’s been the impact on survival rates? British women have about 20% lower survival rates with breast cancer than do American women.

Breast cancer is tragic and traumatic at any age. But breast cancer does not have to cause death if it is caught early with a mammogram so that treatment can be started before it spreads. In fact, if caught earlier, there is a 90% cure rate for women with breast cancer in the United States. American women have the best breast cancer survival rates in the world because of our current guidelines that help early detection.

Cutting back mammograms to every two years beginning at age 50 and ending at age 74 is a change made by a government sponsored panel, much like the ones being set up to decide your care under the Senate and House healthcare “reform” bills now being discussed.

Who were not involved in making these new recommendations? The very physicians you are most likely to see if you feel a lump: cancer specialists, radiologists, and primary care physicians-who are your first ally in getting prompt diagnosis.

The change in guidelines came from the distant and impersonal “review of data” from published studies. This is very different from physicians seeing patients and dealing one on one, face-to-face with the emotional trauma that comes from a cancer diagnosis. As a women’s health physician, I want the best and most timely diagnostic tools available to help my patients determine what’s wrong. I am profoundly concerned that government “experts,” far removed from the daily care of patients, are sitting “on high” to proclaim that women don’t need to start mammograms at age 40.

Even more disturbing: I think some of the reasons these experts have given are paternalistic and demeaning to women. Example: It causes "anxiety" to have a false positive mammogram. So? Women are strong. Women can handle “anxiety.” What is worse? Brief anxiety to find out a lump is not malignant (false positive)? To have the greater trauma and anxiety from waiting until age 50 to have your first mammogram, only to find you have a walnut-sized cancer that has spread to your lymph nodes?

Breast cancers grow slowly. By the time a cancer has grown large enough to be felt, it has generally been there for about 8 to 10 years. Cancers are caught on mammogram that are too small to be felt, so treatment can be started sooner and women live longer. A walnut-sized cancer clearly could have been diagnosed ten years earlier if your first mammogram had been done at age 40, as under today’s guidelines.

For my patients, I am continuing to prescribe annual mammograms beginning at age 40. I believe this is sound medical practice. I believe this is in each woman’s best interest. And I am not going to stop ordering mammograms just because a woman reaches age 74.

Older women are just as worthy of early diagnosis and prompt treatment as are younger women. If you are the woman who is missed because the “guideline” did not fit, it’s your life at stake.

Dr. Elizabeth Lee Vliet Elizabeth Lee Vliet, M.D. is a women’s health specialist who received her M.D. degree and internship in Internal Medicine at Eastern Virginia Medical School, then completed specialty training at Johns Hopkins School of Medicine. She received B.S. and M.Ed. degrees from The College of William and Mary in Virginia. Dr. Vliet is the 2007 recipient of The Voice of Women award from the Arizona Foundation for Women in recognition of her pioneering advocacy for the overlooked hormone connections in women’s health. Dr. Vliet's books include: It’s My Ovaries, Stupid!; Screaming To Be Heard: Hormonal Connections Women Suspect-- And Doctors STILL Ignore; Women, Weight and Hormones; The Savvy Woman's Guide to PCOS. Dr. Vliet is a seasoned expert commentator and a passionate fighter against government takeover of health care in the proposed Health Care "Reform" that seeks to eliminate or penalize private options. Dr. Vliet’s educational medical website is www.herplace.com. Doctor Vliet has been speaking to the healthcare reform issue on many National TV and Cable Networks, including shows such as Stuart Varney, Neil Cavuto, Fox Friends, as well as, many major syndicated radio shows. For more information on healthcare reform, Dr. Vliet suggests two patient advocate Web sites on healthcare: www.JoinPatientsFirst.com, www.PatientsUnitedNow.com or the Association of American Physicians and Surgeons at www.aapsonline.org . Contact: Rose Henning at rosehenning@herplace.com rosehenning@herplace.com , 520-797-9131 (MST).

Metro Group Inc. in no way supports any particular political view point. "Health Care blog" is a forum where both sides of the issue can state their point of view and make their case for their positions on the very important issue of Health Care Reform in the U.S.

The following letter was written by some of the most brilliant minds in the country. It was written by Alan M. Garber, Victor R. Fuchs and Kenneth J, Arrow of the Stanford University Center for Health Policy. This letter urges President Obama to include four elements in the health reform legislation that will help control costs. Please read this letter as it contains valuable information for all Americans that really want health care reform.

By Alan M. Garber, Victor R. Fuchs, Kenneth J, Arrow

November 17, 2009

President Barack Obama
The White House
Washington, DC 20500

Dear Mr. President,

As the full Senate prepares to debate comprehensive health reform legislation, we write as economists to stress the potential benefits of health reform for our nation’s fiscal health, and the importance of those features of the bill that can help keep health care costs under control. Four elements of the legislation are critical: (1) deficit neutrality, (2) an excise tax on high-cost insurance plans, (3) an independent Medicare commission, and (4) delivery system reforms.

Including these four elements in the reform legislation – as the Senate Finance Committee bill does and as we hope the bill brought to the Senate floor will do – will reduce long-term deficits, improve the quality of care, and put the nation on a firm fiscal footing. It will help transform the health care system from delivering too much care, to a system that consistently delivers higher-quality, high-value care. The projected increases in federal budget deficits, along with concerns about the value of the health care that Americans receive, make it particularly important to enact fiscally responsible and quality-improving health reform now.

In developing our analysis and recommendation, we received input and suggestions from Administration officials, including the Office of Management and Budget and others, as well as from economists who disagree with the Administration’s views.

The four key measures are:

Deficit neutrality

Fiscally responsible health reform requires budget neutrality or deficit reduction over the coming years. The Congressional Budget Office (CBO) must project that the bill be at least deficit neutral over the 10-year budget window, and deficit reducing thereafter. Covering tens of millions of currently uninsured people will increase spending, but the draft health reform legislation contains offsetting savings sufficient to cover those costs and the seeds of further reforms that will lower the growth of spending. Deficit neutrality over the first decade means that, even during the start-up period, the legislation will not add to our deficits. After the first decade, the legislation should reduce deficits.

Excise tax on high-cost insurance plans

The Senate Finance Committee’s bill includes an excise tax on high-cost health insurance plans. Like any tax, the excise tax will raise federal revenues, but it has additional advantages for the health care system that are essential. The excise tax will help curtail the growth of private health insurance premiums by creating incentives to limit the costs of plans to a tax-free amount. In addition, as employers and health plans redesign their benefits to reduce health care premiums, cash wages will increase. Analysis of the Senate Finance Committee’s proposal suggests that the excise tax on high-cost insurance plans would increase workers’ take-home pay by more than $300 billion over the next decade. This provision offers the most promising approach to reducing private-sector health care costs while also giving a much needed raise to the tens of millions of Americans who receive insurance through their employers.

Medicare Commission

Rising Medicare expenditures pose one of the most difficult fiscal challenges facing the federal government. Medicare is technically complex and the benefits it underwrites are of critical importance to tens of millions of seniors and Americans with disabilities. We believe that a commission of medical experts should be empowered to suggest changes in Medicare to improve the quality and value of services. In particular, such a commission should be charged with developing and suggesting to Congress plans to extend the solvency of the Medicare program and improve the quality of care delivered to Medicare beneficiaries. Creating such a commission will make sure that reforming the health care system does not end with this legislation, but continues in future decades, with new efforts to improve quality and contain costs.

Delivery system reforms

Successful reform should improve the care that individual patients receive by rewarding health care professionals for providing better care, not just more care. Studies have shown that hundreds of billions of dollars are spent on care that does nothing to improve health outcomes. This is largely a consequence of the distorted incentives associated with paying for volume rather than quality. Health care reform must take steps to change the way providers care for patients, to reward care that is better coordinated and meets the needs of each patient. In particular, the legislation should include additional funding for research into what tests and treatments work and which ones do not. It must also provide incentives for physicians and hospitals to focus on quality, such as bundled payments and accountable care organizations, as well as penalties for unnecessary re-admissions and health-facility acquired infections. Aggressive pilot projects should be rapidly introduced and evaluated, with the best strategies adopted quickly throughout the health care system.

As economists, we believe that it is important to enact health reform, and it is essential that health reform include these four features that will lower health care costs and help reduce deficits over the long term. Reform legislation that embodies these four elements can go a long way toward delivering better health care, and better value, to Americans.

Sincerely,

Dr. Henry Aaron, The Brookings Institution
Dr. Kenneth Arrow, Stanford University, Nobel Laureate in Economics
Dr. Alan Auerbach, University of California, Berkeley
Dr. Katherine Baicker, Harvard University
Dr. Alan Blinder, Princeton University
Dr. David Cutler, Harvard University
Dr. Angus Deaton, Princeton University
Dr. J. Bradford DeLong, University of California, Berkeley
Dr. Peter Diamond, Massachusetts Institute of Technology
Dr. Victor Fuchs, Stanford University
Dr. Alan Garber, Stanford University
Dr. Jonathan Gruber, Massachusetts Institute of Technology
Dr. Mark McClellan, The Brookings Institution
Dr. Daniel McFadden, University of California, Berkeley, Nobel Laureate in Economics
Dr. David Meltzer, University of Chicago
Dr. Joseph Newhouse, Harvard University
Dr. Uwe Reinhardt, Princeton University
Dr. Robert Reischauer, The Urban Institute
Dr. Alice Rivlin, The Brookings Institution
Dr. Meredith Rosenthal, Harvard University
Dr. John Shoven, Stanford University
Dr. Jonathan Skinner, Dartmouth College
Dr. Laura D’Andrea Tyson, University of California, Berkeley

Letter:
http://iis-db.stanford.edu/pubs/22739/Economist_Letter_to_the_President.pdf

The source of the letter:
http://bit.ly/13omUB

OECD Tax Database (Table 0.1):
http://www.oecd.org/document/60/0,2340,en_2649_34533_1942460_1_1_1_1,00.html

Bundled payments and ACOs:
http://www.pnhp.org/news/2009/november/rand-and-br-on-savings-through-bundled-payments

Metro Group Inc. in no way supports any particular political view point. "Health Care blog" is a forum where both sides of the issue can state their point of view and make their case for their positions on the very important issue of Health Care Reform in the U.S.

By Susanne L. King Berkshireeagle.com

Everyone is talking about health care reform and trying to decipher the differences between the bills in the House and the Senate. The “public option” is praised by some and derided by others. Politicians are influenced by the financial support of various interest groups who are lobbying furiously to retain or extend their turf.

Regardless of the legislation Congress passes, the health insurance industry is primed to expand its consumption of U.S. health care dollars by selling more insurance policies to people who are currently uninsured. And American taxpayers are going to subsidize many of these policies, a windfall profit for private insurance companies.

In a statement about why he voted against the House Bill (H.R. 3962) passed this weekend, Rep. Dennis Kucinich said, “In H.R. 3962, the government is requiring at least 21 million Americans to buy private health insurance from the very industry that causes costs to be so high, which will result in at least $70 billion in new annual revenue, much of which is coming from taxpayers. This inevitably will lead to even more costs, more subsidies and higher profits for insurance companies — a bailout under a blue cross.”

Few others in power are discussing the important question, “Is all of this legislation real reform or phantom reform?” Universal coverage is important, but what are the other necessary components of health care reform that American people desire? There are four other important elements beyond universal coverage: choice, adequate coverage, security, and cost-effectiveness.


Read the rest of the article at Berkshireeagle.com

Metro Group Inc. in no way supports any particular political view point. "Health Care blog" is a forum where both sides of the issue can state their point of view and make their case for their positions on the very important issue of Health Care Reform in the U.S.

By Andrew Coates MD


At The New Republic blog Jonathan Cohn goes out of his way to attack Marcia Angell’s clear and courageous article at the Huffington Post.

Mr. Cohn begins with a disclaimer:

I’m a longtime single-payer supporter myself. If Angell could get her way, I’d be thrilled. But Angell can’t get her way.

This old saw is by now condescending, tiresome, gratuitous. Mr. Cohn merely tells us what leading politicians have been telling single payer advocates for decades: real health reform is not politically feasible (so go away!) This is not the stance of a single-payer supporter. It also falls well short of a license for the lame straw man argument that follows.

Mr. Cohn:

To Angell–and to others on the left, as my colleague John Judis notes today–this is reason for ditching the whole effort. But what, really, would that accomplish? The immediate impact would be to undermine Obama and his allies in Congress, creating the (accurate) impression they are incapable of passing major legislation. The Democratic Party would lose seats at the midterms and then, quite possibly, suffer even bigger setbacks two years hence. That’s not exactly a recipe for progressive revival.

Perhaps Angell and those who agree with her that this would be a constructive failure–that eventually growing frustration with our health care system will help us elect even more progressives and pass more ambitious reforms. Well, maybe. But that’s an awfully big chance to take…

Dr. Angell is not writing about electing Democrats! She is writing about health reform.

Dr. Angell:

The danger is that as costs continue to rise and coverage becomes less comprehensive, people will conclude that we’ve tried health reform and it didn’t work. But the real problem will be that we didn’t really try it. I would rather see us do nothing now, and have a better chance of trying again later and then doing it right.

Read the rest of this Blog and others at Physicians for a National Health Program