DaVita launches enhanced portal for dialysis patients

DENVER – DaVita Inc., a provider of kidney care services, announced new features on myDaVita.com to help dialysis patients manage their health. The enhanced website offers a patient health portal, enhanced with a social networking component and a kidney diet helper app.

Billed as a first for dialysis providers, the DaVita Health Portal will help patients understand and manage their kidney care, officials say. The application is accessible anywhere patients have an Internet connection through a computer, including in DaVita dialysis centers.

"At DaVita, we’re committed to improving our patients' quality of life and their quality of care," said DaVita chairman and CEO Kent Thiry. "The enhanced myDaVita.com and the DaVita Health Portal are designed to empower patients and create an online community for patients and caregivers."

Through the DaVita Health Portal patients can:

Track and view graphs of weight and lab resultsView medicationsPrint and share health reports with family, caregivers and physiciansAccess tracking sheets for recording peritoneal dialysis (an alternative to hemodialysis) treatment information

myDaVita.com is an online patient social networking and virtual support center where dialysis patients can connect with other members of the kidney care community by sharing stories, meeting friends who are going through similar experiences, getting advice, and supporting and inspiring others, officials say.

Other myDaVita.com resources include the DaVita Diet Helper, which helps patients navigate nutrition challenges with planned menus and a log to track important nutrients. In the enhanced My Recipes section, patients and caregivers can save and organize favorites from more than 700 kidney-friendly recipes.

The online tools are meant to allow patients to be proactive about their health, which can lead to improved clinical outcomes and an improved quality of life.
 

Clinical Solutions, Fujitsu join forces on improved healthcare access in Spain

MADRID, Spain – Clinical software vendor Clinical Solutions has announced a partnership with Fujitsu Services to help improve access to healthcare and advice for the people of Spain.

With an aging population and chronic conditions on the rise, the escalating cost of healthcare provision is a growing concern for the Spanish Government and regions.

In addition, patient expectations are high, with needs for access to the right healthcare resource, at the right time, and in the right place.

The partnership aims to transform the delivery of quality healthcare through the use of intelligent systems and data analysis - enabling efficient management of resources and appropriate use of emergency, urgent and primary healthcare services. The Clinical Solutions software, branded IntefleCS, has been designed by clinicians and uses flexible, rules-based programmes that provide clinical decision support in either a telephony, in-person or Web environment.

Jose Maria Moyano, director of health at Fujitsu Services, said, "The partnership with Clinical Solutions underpins Fujitsu Services' strategy in Spain, providing innovative healthcare solutions which have already been proven in other countries. The partnership also represents a significant opportunity to improve access to healthcare in Spain, resulting in lower costs, lower risks, higher quality care and ultimately greater patient satisfaction."

Richard Craven, director at Clinical Solutions, said, "This is an exciting opportunity for us to expand our presence in Europe and use our experience, in collaboration with Fujitsu Services, to demonstrate the benefits of technology as a means of improving access to healthcare."

Clinical Solutions's IntefleCS Telephone Triage software is already used in the UK by NHS Direct, the largest telephone triage system in the world, reaching more than 55 million people in England and Wales.

The IntefleCS Health Watch solution is also playing a role in government initiated national services to help prepare planning for pandemic outbreaks and national emergencies.

Adopted by the Department of Health in the UK, the solution is a key component to delivering a multi-channel National Pandemic Flu Line Service to the entire UK population.

In addition to these national services, the IntefleCS Face to Face solution is used by a large number of UK Walk-in Centres, helping to provide the general public with a convenient way to access healthcare services.

Heart disease in men can be fought head-on

Heart disease is the No. 1 killer of men (and women) in the USA, so it's no wonder that cardiologist Gordon Tomaselli dispenses direct, no-nonsense advice: "Get up and move more, don't smoke, make sure you control your blood pressure and cholesterol, and don't ignore symptoms of heart disease, particularly if you have a family history."

It may sound difficult, but the results could be lifesaving, says Tomaselli, president of the American Heart Association (AHA) and director of the division of cardiology at the Johns Hopkins University School of Medicine in Baltimore.

Heart disease or cardiovascular disease are umbrella terms used to describe disease processes of the heart.

Although the rate of death from cardiovascular disease declined by 31% from 1998 to 2008, the disease is still the leading cause of death in the USA. One in every three deaths are from heart disease and stroke, according to the heart association and the Centers for Disease Control and Prevention.

Men often develop and die from heart disease at a younger age than women, says Russell Luepker, Mayo professor of public health at the University of Minnesota and a spokesman for the American Heart Association. "While more women die of heart disease, they die at a later age from it than men."

Why men are vulnerable

Men suffer from the disease at a younger age because they "tend to have higher blood pressure, higher cholesterol, and they are more likely to be smokers than women," says Luepker, program director of the Minnesota Heart Survey, a population-based study that tracks trends in heart disease.

And men are less likely to be treated for high blood pressure than women, he says. "Men are not seekers of care. We did a study a couple of years ago, and we autopsied people who were under 60 who died a premature, sudden death � 95% of them were men. Practically all of them had heart disease. They all had physicians and medical insurance but rarely went to the doctor.

"They may have gone to the doctor because they cut their finger with a hedge trimmer, but they weren't going in and being evaluated for heart disease."

Ways to live a heart-healthier life

Get active. Get at least 30 minutes of moderate physical activity each day like brisk walking, five times a week.�Make a commitment that you are going to be more active today than you were yesterday ,� says cardiologist Gordon Tomaselli, president of the heart association.

Eat better. Avoid excess salt which leads to hypertension, and saturated fats which leads to high cholesterol, Tomaselli says. Also, limit sugar intake. Instead eat fruits, vegetables, whole grains, fish, poultry, low-fat or non-fat dairy and other healthy fare.

Manage your blood pressure. Normal blood pressure is less than 120/80. If it�s within healthy ranges, you reduce the strain on your heart, arteries, and kidneys, the heart association says.

Control cholesterol. �Your total cholesterol and LDL (bad) cholesterol should be low, and your HDL (good) cholesterol should be as high as possible,� Tomaselli says. If your total cholesterol is 200 or higher, you need to take action. High cholesterol can cause blocked arteries, and like a multi-car pile-up, one problem often creates another.

Don�t smoke. �Tobacco at any level of intake is bad for your health and should be avoided,� Tomaselli says.

Lose weight. Being obese � roughly 30 or more pounds over a healthy weight � increases the risk of heart disease.

Source: American Heart Association (mylifecheck.heart.org)

One big problem for men is a lot of them don't manage their blood pressure as well as women do, he says. "It's better than it was 10 years ago, but women still do better."

High blood pressure is the most significant risk factor for heart disease, Tomaselli says. It means the blood running through your arteries flows with too much force and puts pressure on your arteries, stretching them past their healthy limit and causing microscopic tears, the heart association says.

Unfortunately, the scar tissue that forms to repair those tears traps plaque and white blood cells, which can lead to blockages, blood clots and hardened, weakened arteries, the heart association says.

One in three adults have high blood pressure, but many people don't even know they have it, the heart group says. The risk can be reduced by following a healthful diet, including cutting back on salt; exercising; keeping a healthy weight; managing stress; limiting alcohol; and avoiding smoking, Tomaselli says. But some people who do those things may still need medication, he says.

If one prescription medication for hypertension doesn't work, you usually can find another that is going to cause you few or no side effects, Luepker says.

Maintain your plumbing

Heart disease is largely preventable, says Gina Lundberg, a cardiologist in Atlanta.

She tells her patients that there are multiple things that can go wrong with your heart, just like the things that go wrong with your house. Your heart, like your house, has plumbing, electricity, doors and walls.

The plumbing in your heart is the coronary arteries that can get blocked up, Lundberg says. The heart has an electrical system that can result in irregular heartbeat or arrhythmia. The doors of the heart are the heart valves and the valves can leak or not open properly and need to be replaced. The walls of the heart can be weak or enlarged which can lead to congestive heart failure, she says.

Adds Tomaselli: "If you have known risk factors for heart disease � diabetes, high blood pressure, high cholesterol, you need to get them under control. It's better to be safe than sorry."

Health Care Reform: We’re Not Done Yet

The Supreme Court has spoken. The Affordable Care Act, briefly on the ropes, has been blessed as the law of the land.

Too many feel that health reform is finally finished and we can move on to the big three issues: the economy, jobs and the deficit. However, because health care is the 800-pound gorilla of the economy, those issues cannot be solved without more far-reaching health reform.

Sorry, lawmakers, but you are going to need to get back in the ring to answer a fundamental question: what is the most cost-effective and constitutional way to finance health care so that we can have quality, affordable health care for everyone?

The answer � single-payer national health insurance, also known as an improved Medicare for all � would save America hundreds of billions of dollars annually. And as the Supreme Court reaffirmed, a program of this type, financed by taxes, is definitely constitutional.

Outrageously, this simple solution was never discussed in the two contentious years of debate surrounding the creation of the ACA because it was deemed �politically impossible.�

�Politically impossible� means that the mere utterance of �single payer� would be enough to prompt the medical-industrial complex, especially the pharmaceutical and insurance industries, to funnel millions of dollars in campaign contributions and lobbying money to opponents of real reform and to tea party groups in order to keep the status quo.

So America continues to promote the least cost-effective way of financing health care, which means that we spend twice per capita on health care than any other nation on earth.

When we were the global leader as we were back in the mid-20th century, we could afford to do this. However, we cannot afford our health care system anymore. It is hopelessly complex, bureaucratic, and outrageously expensive. Employers have shifted the cost to employees and it will only get worse as private insurers raise their premiums.

Beyond skyrocketing premiums, about 18 percent of our gross national product is consumed by health care. That figure will rise to 20 percent by the end of the decade. In order to fund this inefficient system, we have borrowed trillions of dollars over the past 50 years, transforming us into the world�s greatest debtor nation.

No matter who wins the November election, the next administration will be forced to confront the deficit. Unfortunately, it appears that our lawmakers� tunnel vision only offers slashing Social Security, Medicaid and Medicare for the poor and elderly as a way to reduce government spending. That course would be catastrophic.

No one seems to want to confront the fact that unless we are willing to embrace an improved Medicare for all, with its streamlined administration and bargaining clout, we have no hope of controlling health care costs, ensuring that our country will remain in debt. Had we adopted a single-payer system 20 years ago, we would have turned our national debt into a surplus today.

In a global economy, employers have to add the cost of health insurance to every product or service. When that cost is twice what the world spends, it eventually means that we are pricing our products too high. Manufacturers have moved their major factories overseas because of lower labor costs, of which health insurance is a key component.

Entrepreneurs are everywhere in America, but too many are locked into undesirable jobs because they need the health benefits. Those who want to put their toe into the self-employed world stop because of the risk of losing health benefits which is bad for an economy that needs creativity and risk.

State and local governments are being weighed down by pension obligations and retiree health benefits. Under a single-payer system, Philadelphia could be freed from the unpredictability of these costs and use those precious dollars for our schools, streets, or public safety.

An ABC/Washington Post poll shows that less than 40 percent of Americans view the ACA or the status quo favorably � remarkably low for a �uniquely American� solution.

Our politics have robbed us from even discussing a practical, commonsense solution � improved Medicare for all — that we desperately need in America. If the medical-industrial complex continues to win, health care costs will continue to rise, and the American people will be the losers.

Dr. Walter Tsou is former health commissioner of Philadelphia. He is a board adviser to Physicians for a National Health Program (www.pnhp.org) and resides in Philadelphia.

Presbyterian Church (USA) Steps Toward Health Insurance Divestment

July 7th, 2012 � Today the Presbyterian Church (USA) took a step toward divestment from for-profit health insurance companies in the US by instructing the appropriate committee of the General Assembly to begin a process of information gathering. The Mission Through Responsible Investing Committee (MRTI) is instructed by the General Assembly of the Presbyterian Church (USA) to request information and explanations of health insurance companies.

This information will focus especially on the insurers� practices in regard to state and federal lobbying expenditures and political campaign contributions, government subsidies and profit margins, denials of claims, and top executives� compensation packages. Other directives include a conversation with the Board of Pensions, the overseeing body that works with the health care provider, to ensure that the church�s health plan submits to the same standards that it asks of other insurers. Based on its analysis MRTI will evaluate the variance between church principles of universal access and affordability on the one hand and corporate objectives on the other. It will also assess the likelihood of significant change in corporate behavior.

In addition, the committee is to recommend measures to the appropriate Council of the church, including possible divestment from the health insurance companies, measures that will strengthen the integrity of the church�s practice. The relevant committees and councils are requested to report on their action to the General Assemblies of 2014 and 2016, with an eye to guiding individual Presbyterians, congregations and mid-councils, in relation to their own investment holdings in this major part of the economy.

Finally, all official bodies are encouraged to continue to support cost-effective health coverage for all through the single payer (or expanded Medicare) model common elsewhere in the developed world, and to support making health care affordable and transparent.

The overture for this step originated with the Mid-Kentucky Presbytery, was joined by the Presbyteries of Albany, New York City, Long Island and West Jersey, and was approved overwhelmingly by the Committee on Health Issues of the General Assembly on July 3, 2012.

More information here.

Staph Infections Tied To Misuse Of Drug Vials

Sean Locke/iStockphoto.com

Misuse of a medical vials can spread infections.

Ten people were hospitalized and one was found dead after contracting staph infections from injections received at health clinics in Delaware and Arizona in early spring, according the Center for Disease Control and Prevention.

The infection clusters were described in the latest Morbidity and Mortality Weekly Report.

Seven people were infected at a Delaware orthopedic clinic and four people at a pain management clinic in Arizona after receiving injections from drug vials intended for use with a single patient but that were instead used multiple times, the report and state health officials said.

Patients at the Arizona clinic were infected with methicillin-resistant Staphylococcus aureus, or MRSA, and patients in both outbreaks were hospitalized.

 

One patient was found dead at home six days after receiving treatment at the Arizona clinic, but the report says Arizona officials didn't declare MRSA the official cause of death.

The outbreaks are two of 20 that have been caused by misuse of single-dose vials since safety standards were reinforced in 2007, according to the CDC.

Needles or syringes weren't reused in either clinic, according to Arizona and Delaware state health officials, unlike a high-profile series of hepatitis C infections at a clinic in Las Vegas a few years back. But vials containing drugs intended for one person were used multiple times.

Drugs in single-use vials lack preservatives that prevent the growth of bacteria and subsequent spread of infections between people, CDC spokeswoman Rosa Herrera told Shots.

Health workers sometimes reuse vials when the amount of medicine they contain exceeds the dose needed for a single patient. One factor in the Delaware outbreak was a national shortage of single-dose vials of the anesthetic bupivacaine.

"Medications come in very large vials, but they're often only approved for use in one person," Herrera said. "Health care providers see that as waste. There's a desire to use what you've paid for. And they don't understand that they're putting their patients at risk."

Herrera said CDC is urging clinics dealing with shortages to split doses safely in pharmacies � not where patients receive treatment.

Of the ten patients hospitalized, the stays ranged from three to 41 days. One patient treated in Arizona also needed long-term care, according to the report.

According to Delaware and Arizona health officials, both clinics remain in operation.

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

Will Medicaid Bring The Uninsured Out Of The Woodwork?

Win McNamee/Getty Images

Texas Gov. Rick Perry is the latest state executive to say no to an expansion of Medicaid.

Ever since the Supreme Court decided last month that an expansion of Medicaid under the Affordable Care Act should be optional, quite a few Republican governors have been vowing to take a pass.

On Monday, Texas Gov. Rick Perry declared that he won't be expanding Medicaid. He joins other GOP state executives who have rejected offering Medicaid to people with incomes up to 133 percent of the poverty line. This year that's just under $15,000 a year for an individual, or a little over $25,000 for a family of three.

"We're not going to participate in any exchanges," Perry said on Fox News. "We're not going to expand Medicaid. We're just not going to be a part of, again, socializing health care in the state of Texas. And going in direct conflict with our Founding Fathers' wishes and freedom, for that matter."

 

Perry and his colleagues say they're rejecting the health law for mostly ideological reasons. That's because when it comes to Medicaid, the states don't appear to be on the hook for very much money.

"The law provided 100 percent coverage for people newly eligible for Medicaid by the federal government, and 90 percent in the out years," says Jeff Goldsmith, a health policy analyst who teaches public health at the University of Virginia.

Compare that to the rest of the Medicaid program, where the federal government pays an average of just under 60 percent.

But it's not just those newly eligible people states are worried about.

Related NPR Stories Texas Gov. Perry Says No To Medicaid Expansion July 9, 2012 Medicaid Expansion: Who's In? Who's Out? July 5, 2012

"Folks don't really understand the struggle states are in," says Dennis Smith, secretary of the Wisconsin Department of Health Services and former head of the federal Medicaid program under President George W. Bush.

Smith says this year his state put more than a billion dollars into its existing Medicaid program. "And that took up literally almost the entire new revenues available to the state � meaning revenues not just for health care, but also intended for education, transportation, law enforcement and everything else," he says.

Even so, Wisconsin had a $600 million budget shortfall. "So states just don't have the dollars, even with those enhanced federal match rates," Smith says.

But what really has many state leaders worried is something called the "woodwork effect." When big parts of the health law go into force in 2014, they worry it will bring out of the woodwork the millions of people who are already eligible for Medicaid but aren't already enrolled.

When some people look to see if they can get health insurance through one of the health exchanges, they may discover a cheaper option. "They will find out that they're actually eligible for Medicaid," says Bruce Lesley, president of First Focus, an advocacy group for children and families.

But many of those people signing up for Medicaid won't be members of the newly eligible expansion group, whose bills will be largely paid by the federal government. They'll be regular old Medicaid beneficiaries, and states will have to pay up to half their costs.

Goldsmith says what has state officials most worried is how easy it will be for these currently eligible but unenrolled Medicaid recipients to sign up.

"It won't be an in-person visit, it won't be a 'bring six forms of ID,' " he says. "There will be an expedited � lubricated, if you will � process to get people onto the rolls, and I think that's the part that's giving state budget officers serious indigestion at this point."

Goldsmith says state officials he's talked to worry that Medicaid, already the largest piece of almost every state budget, could end up dwarfing everything else.

"The health and human services secretary of Louisiana told me that at full implementation, 48 percent of the citizens of his state would be on Medicaid," he says. "And I strongly suspect that [as] you go across the Southern tier of the United States, you'll see a lot of those states in the 30s. A third of their citizens eligible for or potentially enrolled in Medicaid."

HHS

Click on image to read Sebelius' letter to governors.

That has some states looking at cutting back their Medicaid programs even now. Wisconsin's Dennis Smith, who used to run the federal Medicaid program, says he reads the Supreme Court decision as allowing that.

But the Obama administration disagrees. Last night it sent a letter to all the nation's governors, noting that "the Court's decision did not affect other provisions of the law." An administration official confirmed that included the requirement that states maintain current eligibility levels until the year 2014.

Health advocate Lesley, a former Capitol Hill staffer, agrees with the administration. "Our reading of the Supreme Court ruling is [that] the opinion by Justice Roberts ... cites basically a specific section of the law and basically changed the idea that the Medicaid expansion can no longer be a mandatory thing, but now is optional," Lesley says. "However, what it didn't touch on was this idea of requiring states to maintain coverage. So we believe that that is absolutely still in place."

mHealth: Embraced by developing world, resisted by developed countries

NEW YORK – A new study of the global mHealth market finds that consumers and developing countries are driving its growth, while physicians are reluctant to adapt.

Those are some of the conclusions drawn from “Emerging Health: Paths for Growth,” published by PricewaterhouseCoopers. The 48-page report, based on two separate surveys conducted by the Economist Intelligence Unit and analyzing 10 nations, indicates developing nations are quicker to accept and adopt telehealth because it’s seen as a way to increase access to healthcare, while developed nations like the United States are being dogged down by regulatory hurdles and a resistance to change among providers.

[See also: Doctor or patient? Who will drive mHealth?]

“Consumers are demanding and payers are willing to pay, but providers aren’t willing to provide,” said Christopher Wasden, PwC’s global healthcare innovation leader. “What we are going to need to do is get providers to think and act differently.”

“To what extent are physicians in their country willing to adapt?” he asked.

Wasden and David Levy, MD, also a global healthcare leader for PwC, said mHealth is more of a disruptive force in developed nations because it challenges the status quo and forces providers and payers to accept that patients have more control of their healthcare choices. Wasden said many doctors are wary of giving the patient more access to medical data and control because they fear – incorrectly – that they will lose business.

[See also: New report offers insight into fragmented mHealth market]

In developing countries, meanwhile, mHealth is seen as a new market with exciting possibilities. New startups and business models, with assistance from the telecommunications sector, Wasden said, are driving mHealth to unprecedented levels of growth. That, he said, is why the African nations and India are among the hotbeds for new innovation in mHealth.

In developed nations, meanwhile, providers – and to a lesser extent payers – say there are too many barriers to mHealth. More than one-quarter of those surveyed in both categories say the conservative culture in healthcare is a leading barrier; others include complex regulations and technology, lack of access to wireless services; and massive changes to the physician’s workload.

Nearly half of the patients surveyed, meanwhile, indicate that in the next three years, mHealth will improve the convenience (46 percent), cost (52 percent) and quality (48 percent) of their healthcare.

“Despite demand and the obvious potential benefits of mHealth, rapid adoption is not occurring,” Levy said. “The main barriers are not the technology but rather systemic to healthcare and inherent resistance to change. Though many people think mobile health will be ancillary or bolted on to the healthcare industry, we look at it differently: mHealth is the future of healthcare, deeply integrated into delivery that will be better, faster, less expensive and far more consumer-focused.”

While physicians are wary of the empowered patient (the report indicates 42 percent of doctors surveyed worry that mHealth will make their patients too independent), Wasden said they “completely miss” the benefits of instant access to healthcare data. He said healthcare costs can be brought down if patients change their behaviors, and that can be accomplished if they work with physicians and use real-time data to monitor and manage their lifestyles.

“We know what will really change patient outcomes … but physicians don’t believe they can change patient behaviors,” he said.

According to the report, only 27 percent of physicians encourage patients to use mHealth to become more active in managing their health, while 13 percent actually discourage it.

Wasden said the popular perception that payers are opposing mHealth in the United States is wrong. The report indicates 40 percent of payers surveyed encourage patients to let doctors monitor their health and activities and to use mHealth (compared to only 25 percent of physicians). Payers, he said, are feeling threatened by healthcare reform, and are adopting new technologies like mHealth in order to adapt to the changing healthcare landscape. They’re supporting measures that allow patients to be treated in their homes and in clinics – anywhere but the hospital, which he said is the “most expensive place to treat a patient.”

That doesn’t mean hospitals should fear mHealth. Wasden said America’s broken healthcare system – and the healthcare systems of many developed nations – are suffering because 30 percent to 50 percent of the patients in hospitals don’t need to be there, thus causing overcrowding and waste. Taking that percentage out of the hospitals, he said, reduces healthcare costs dramatically and frees up hospitals to treat only those who should be treated there.

Wasden said the PwC report points out that mHealth adoption will take time and effort. Eventually, he said, what’s called “mHealth” will evolve into “healthcare.”

“We need to be realistic that we are in the very early stages,” he said.

A full copy of the report is available for download here.

[See also: mHealth moving forward fast, experts say]

Does your state protect older Baby Boomers?

The Affordable Care Act leaves it to the states to decide whether they will allow insurers to charge older Americans more for coverage. If a state takes no action, a 64-year-old buying his own health insurance in the individual market will pay up to three times more than an 18-year-old.

The Affordable Care Act leaves it to the states to decide whether they want to let insurers charge older Americans more for coverage. If a state takes no action, a 64-year-old buying his own insurance in the individual market will pay up to three times more than an 18-year-old. In the small-group market � if a small business employs an unusually large number of older workers � the same 3:1 ratio applies.

Today, in most states, there are no caps on how much insurers can charge a 60-something forced to purchase his own insurance. In the individual market, only New York State bans age rating altogether, and just three other states limit how much premiums can vary, based on age, to less than 3:1. When insurers sell policies to small businesses, Vermont also prohibits age rating, but only five other states cap increases.

To check whether your state shields older boomers in either of these markets, take a look at these charts. (A checkmark in the right-hand column means that age rating is now unregulated in that state.)

Help from the younger generation?

Under reform, more states could decide to ban age rating, or follow Massachusetts' example, and limit the ratio to 2:1.�But, politically, this would be a third-rail decision.

If older boomers pay less, younger adults would be charged more, and most are vehemently opposed to being asked to support the Pepsi Generation. As one of my younger readers once commented, "I'm willing to help my mother, but not someone else's mother."

Just how much more would a 20-something pay?�According to researchers at the Urban Institute, eliminating age rating would lift average premiums for those 18 to 34 years old by $1,400 (from $3,600 to $5,000). Policy holders ages 35 to 44 would see their premiums rise by $800 (from $4,200 to $5,000). Meanwhile, premiums for those between age 45 and 64 would fall by about $2,400, from $7,500 to $5,100.

In other words, when costs are distributed over a large group, older adults save more than younger adults lose.

Still, many believe that older Boomers can and should pick up the higher tab for their own care. After all, throughout their financial lives, they have been luckier than most: they enjoyed first crack at the employment market when jobs were plentiful, and first dibs on housing when homes were affordable.

A generation hit hard

Yet in recent years, the economy has not been kind to the rock ‘n roll generation. One in six is now unemployed, and from 2000 to 2011, the average (mean) after-tax income of Americans age 45 to 54 (who are now in their 50s and early 60s) plunged by 13.3 percent.

By that measure, the recession has hit them harder than other age groups except Americans aged 15 to 24. Over those years, this cohort should have been enjoying their peak earning years. But as the chart below reveals, they didn't.

Between 2000 and 2011 average after-tax income of Americans age 45 to 54 plunged by 13.3 percent. Graph: Advisor Perspectives, Inc.

Even worse, the Wall Street Journal reports, "at an age when they should be generating peak … savings," many have been raiding their retirement funds and "applying for early Social Security benefits." Among median-income households headed by someone age 55 to 64, total savings and assets stand at just $87,200. In 2014, they will be the 50- to 64-year-olds struggling to scrape together $7,500 to $8,500 to purchase health insurance in the individual market.

Of course, younger middle-class Americans also have watched their incomes slide, but time is on their side. They have many more years to recover. The problem for a jobless 60-year-old is that she won't be able to make up for her losses unless she finds a higher-paying job � and that isn't likely.

In 2014, just how many older Americans will find that they can't afford universal coverage? Writing in Health Affairs in February, the Urban Institute's researchers estimated that under reform, age rating means that roughly 1 million Americans age 45 to 64 will forego insurance.

Abolish age rating?

Yet there's a trade off: if age rating were abolished, younger adults would be charged more, and some would decide they can't afford insurance. Bottom line: "the number of uninsured older Americans would be roughly offset by increases in the number of uninsured adults in the two younger age groups�(18-34 and 34-44)."

This worries policymakers for two reasons. First, we need young, healthy Americans in the pool to keep insurance costs down. Secondly, if young families decide to forego insurance, many won't buy separate policies for the children.

How do we choose between children and their grandparents?

If we don't want to ration care, the only rational solution is to bring down the cost by trimming waste in our health care system. This will be difficult. Most of the fat isn't hanging out on the edges of the steak � it's marbled throughout in the form of unnecessary treatments and over-priced products. It needs to be removed carefully, with a scalpel. But it can be done.

Leapfrog grades hospitals A to F on patient safety

WASHINGTON – A new report card from healthcare watchdog The Leapfrog Group ranks hospitals for patient safety – A through F. Infections, medication and medical error and injuries are still rampant, according to Leapfrog's survey. Massachusetts hospitals ranked high. Those in the nation's capitol had the lowest average scores.

Approximately 400 people die every day because of hospital errors – the equivalent of a jet crashing every day and killing all aboard, Leapfrog notes. In response to this silent epidemic, more than 2,600 U.S. hospitals will now receive an A, B, C, D or F Hospital Safety Score based on patient safety via a first-of-its-kind initiative.

[See also: Leapfrog Group names top hospitals for 2011]

A blue ribbon panel of the nation’s top patient safety experts provided guidance to the Leapfrog Group, an independent national nonprofit run by employers and other large purchasers of health benefits, to develop the Hospital Safety Score. The Hospital Safety Score is calculated using publicly available data on patient injuries, medical and medication errors, and infections.

Not all hospitals earned an A, and there are some surprises, including hospitals with outstanding reputations for quality appearing with Hospital Safety Scores of B, C or below.

"The Hospital Safety Score exclusively measures safety – meaning errors, accidents, and infections," said Ashish Jha, MD, of Harvard, a member of the blue ribbon expert panel. "Even hospitals with excellent programs for surgical and medical care, state-of-the-art diagnostic equipment, and dedicated physicians may still need this score as a reminder that patient safety should be a top priority."

[See also: Most hospitals fall short on safety measures, Leapfrog survey shows]

"The Leapfrog Group’s goal is to give patients the vital information they need and deserve before even entering a hospital," said Leah Binder, president and CEO of the Leapfrog Group. "We hope people will use this score to talk with their doctor, make informed decisions about where to seek care, and take the right precautions during a hospital stay."

For the first time, the Hospital Safety Score will highlight the country’s best hospitals and warn against the worst to save lives and bring attention to the nation’s silent safety epidemic. According to recent studies, one in four Medicare patients will leave a hospital with a potentially fatal issue they didn’t have prior to hospitalization. On average, one medication error per day occurs for each hospitalized patient, and more than 180,000 Americans die every year from hospital accidents, errors, and infections.

The Hospital Safety Score website allows visitors to search hospital scores for free, and also provides information on how the public can protect themselves and loved ones during a hospital stay.

"The Leapfrog Group board has been frustrated with the lack of progress in improving patient safety, despite significant industry efforts over the past decade," said David Knowlton, immediate past chair of the Leapfrog Group Board of Directors and chair of the Leapfrog Group’s Patient Safety Committee. "It is time for a game changer. It’s time to give American families the heads-up they need to protect themselves if they face the need for a hospital stay."

The Leapfrog Group’s membership of employers and other purchasers of health benefits, and business coalitions on health across the country, will be working to engage communities, employers, health plans, and hospitals in using the Hospital Safety Score to improve safety, Leapfrog executives said. The Hospital Safety Score will be reissued using updated data in November 2012, with an annual Hospital Safety Score to follow in 2013 and beyond.

Key findings:Of the 2,652 general hospitals issued a Hospital Safety Score, 729 earned an A, 679 earned a B, and 1243 earned a C or below.A wide range of hospitals earned A's with no one class of hospitals dominating among those showing the highest safety scores.Hospitals earning an A include academic medical centers Massachusetts General, NYU Langone Medical Center, and University of California San Francisco. Many rural hospitals earned an A, including Grinnell Regional Medical Center in Iowa and Baptist Health South Florida Homestead Hospital in Florida.Hospitals with myriad national accolades, such as Mayo Clinic, Virginia Mason Medical Center, and University of Michigan Medical Center, each earned an A.

Less predictable were the A scores earned by hospitals serving highly vulnerable, impoverished, and/or health-challenged populations, such as Bellevue Hospital, Montefiore Hospital, and Detroit Receiving Hospital.

"A" scores were awarded to for-profit hospitals including many in the HCA systems, as well as hundreds of not-for-profit and public hospitals.

Community hospitals showed excellence as well, such as OSF St. Joseph Medical Center in Illinois.

More on methodology and panel experts on next page.

Would single-payer healthcare be less vulnerable to the court than the ACA?

If the Supreme Court does decide to strike down any or all of the Affordable Health Care Act, the implications will range from the political to the medical to the economic.

For me, such a decision will take its place among the more supremely ironic of unintended consequences: a law designed to avoid greater government intrusion into health care will have been invalidated as an unconstitutional overreach of government power, while a far more intrusive approach would have clearly passed muster.

How could this be possible? Welcome to the wonderful world of constitutional interpretation.

Let�s begin by imagining that Congress and the president decided to adopt a genuinely radical health care plan�the kind in place in most of the industrialized world. They decide on a �single-payer� system, where the government raises revenue with taxes, and pays the doctor, hospital and lab bills for just about everyone.

Put aside the question of whether this is a good idea, or an economically sustainable notion. The question is: would such a law be constitutional?

The answer, unquestionably, is �yes.� In fact, it would be the simplest law in the world to enact. All the Congress would need to do is to take the Medicare law and strike out the words �over 65.� Why is it constitutional? For the same reason Medicare and Social Security are: the taxing power. Its reach is immense. During World War II, the maximum income tax rate was 91 per cent (it was paid by few, thanks to loopholes, but still). The same Congress that could abolish the estate tax could set just about whatever limit it chose; it could impose a 100 percent tax on estates over, say, $5 million. If it decided that a national sales tax was an answer to huge budget deficits, it could impose one at whatever level it chose.

(The remedy, of course, lies with the voters, who would be more than likely to send a powerful message at the next election, which is why the lack of constitutional limits on the taxing power do not lead to confiscatory rates.)

So why is Obama�s health care plan, with a far more modest use of government power, in serious jeopardy? It�s because the key element in the plan�the �mandate� to purchase health insurance or pay a penalty�was not based on the taxing power, but on Congress�s power, under Article I, Section 8, to regulate interstate commerce. And that power, while broad, has its limits…even if those limits are murky.

Up until the late 1930s, those limits were more like shackles. The Supreme Court repeatedly struck down sate and federal laws regulating wages, hours and working conditions on the grounds that the commerce power only touched the distribution of goods, not their manufacture. But once the court changed its mind�after an effort by FDR to �pack� the court with additional justices had failed�there seemed to be no limits at all. Back in 1942, the court said the government could stop a farmer from growing his own wheat for his own use, because of the potential effects on the wider market. But in 1995, for the first time in decades, the court said �no� to a federal law based on the Commerce clause�one banning firearms within school zones�because it could find no reasonable connection between the law and interstate commerce.

In the health care case, the questioning by several justices indicated strong skepticism about the mandate. If the commerce clause can compel a citizen to buy a specific product�in this case, health insurance�what couldn�t it do? Could it, as the now famous question had it, compel citizens to buy broccoli on health grounds? (Well, a defender might have pointed out, the government does compel taxpayers to �pay for� all kinds of things in the form of government subsidies, such as ethanol. It could clearly do the same with a broccoli subsidy.)

As a policy matter, it�s clear that a �mandate� is a much more modest extension of government power than a single-payer system. The citizen would choose which insurance to buy; in fact, under the law, a citizen could choose not to buy any insurance, and pay a penalty instead. The whole premise of a mandate is to spread risk as widely as possible; as Mitt Romney used to note when he was defending the Massachusetts plan he designed, the mandate to prevent �free riders� from benefitting from treatment once they are sick or injured. That�s why the genesis of the idea came from such conservative roots as the Heritage Foundation.

As a constitutional matter, however, the idea of compelling a citizen into a specific economic activity raises alarm bells. It evokes the specter of some bureaucrat inviting himself into your home, while checking the shelves to make sure you�ve purchased multigrain cereal and cage-free eggs. (It�s a specter the administration tried to avoid by arguing that the health-care market is unique, one in which we are all likely participants at some point, voluntarily or otherwise. Unlike life in a Robert Heinlien libertarian �utopia,� hospital ERs do not have the power to say to an uninsured heart attack or auto accident victim: “you chose not to buy insurance? Sorry…have a nice day.�)

So, for its effort to design a health care plan that moved in the direction of less government intrusion, the Obama administration faces the distinct prospect of having its signature domestic program shot down for exceeding the limits of the constitutional power it did choose to use.

I somehow doubt the White House will appreciate the irony.

Top CEOs offer checklist for better healthcare

WASHINGTON – Some of the nation's top healthcare CEOs have issued a 10-item checklist for spurring high-value healthcare that includes health IT best practices.

The checklist is part of a discussion paper the CEOs authored that bears the emblem of the Institutes of Medicine. However, it also carries a disclaimer that the views expressed in the discussion paper are not necessarily those of the authors’ organizations nor of the IOM.

[See also: IOM to release new report on health IT and patient safety]

"The Checklist’s 10 items reflect the strategies that, in our experiences and those of others, have proven effective and essential to improving quality and reducing costs," the authors write.

On the topic of IT, they state: “Reliable information systems are critical not just to ensure care quality, but also to improve efficiency in administrative and other process measures.”

In keeping with their precept of “continuous improvement,” the CEOs ask themselves and their senior leaders these questions about IT:How well is our IT system used to help providers streamline administrative tasks and improve the care experience and patient outcomes?How well is our EHR aligned with meaningful use requirements?

[See also: IOM finds healthcare data for children lacking]

They also present examples of how IT best practices resulted in better care and millions in savings at their organizations.

At Geisinger Health System, for example, IT helped lower costs over the past five years, saving $1.7 million from reduced chart pulls; more than $600,000 from reduced printing and faxing; more than $500,000 per year from reduced nursing staff time through ePrescribing; and more than $1 million from reduced transcription.

The checklist and a list of the authors and their affiliations are on the next page.

Eric Massa: The Single Payer Moment (video)

Eric Massa of New York�s 29th District has been making the case for single payer healthcare. The advice he was given when he decided to run for congress was, “don�t do it.” As a first year congressman he�s been advised not to take a stand, especially on a hot button issue like healthcare. But rather than accept the conventional wisdom, Massa has voted against the bank bailout and fought loudly for single payer healthcare. A cancer survivor, Massa says that the healthcare system in this country is literally killing people. And Massa says that he hopes a public option is part of any healthcare bill that emerges from congress this year.

Protests at White House healthcare hearing in Iowa

By Kay Henderson for Reuters–

DES MOINES, Iowa (Reuters) – The latest White House regional forum on healthcare drew protests and complaints on Monday along with a promise that government-run insurance was at least on the table for discussion.

“Why are we having this shameful event?” said Mona Shaw, a political activist, at the start of the session. “People are dying,” she said, because of what she termed a callous insurance industry.

Iowa Governor Chet Culver who chaired the event cued up a video message from President Barack Obama as security personnel escorted Shaw from the room.

It was the third of five regional meetings which Obama hopes would help Congress figure out how to overhaul the U.S. healthcare system, which is the most expensive in the world even though some 46 million Americans have no health insurance.

Obama plans to make sweeping changes to the system this year to try to cut the number of uninsured while improving the quality of care and controlling costs that are forecast to reach $2.5 trillion dollars this year.

About 20 protesters at the meeting waved signs and chanted “Everybody in, nobody out” — a demand for universal coverage.

Dr. Jess Fiedorowicz, a psychiatrist at the University of Iowa Hospitals who was with the protest group, told the meeting a majority of Americans support a “single payer” or government-run national health insurance program.

“Can we put it on the table for discussion?” Fiedorowicz asked Nancy-Ann De Parle, director of the White House Office on Health Reform.

“Can we study costing? Can we study feasibility of this truly universal, socially just and fiscally responsible alternate to our currently unjust and woefully inefficient system?” Fiedorowicz asked. Many in the crowd applauded.

Vashti Winterburg, 61, co-chair of Kansas Health Care for All, said she opposes any plan that keeps health insurance companies in business.

She said the Kansas nonprofit board she serves on is finding it more and more difficult to pay the premiums of workers who provide in-home care to the elderly.

Chris Peterson, 53, who farms near Clear Lake, Iowa, said he cannot buy private health insurance for his wife or himself two years after his insurance carrier dropped them. They now have $14,000 in medical debt.

From Reuters.com.

Maine's HIE goes to Dell's cloud for image-sharing

PORTLAND, ME – A picture is worth a thousand words, the old saying goes. Today, HealthInfoNet, Maine's statewide health information exchange, is launching a pilot that will put both images and words at the fingertips of healthcare providers – the better to make the right decisions for their patients.

Working with Dell, HealthInfoNet will create what its officials say is the nation’s first statewide medical image archive.

[See also: Maine HIE to match outcomes with cost]

"This is totally a cloud-based offering, which will be a subscription model, where we will charge on a per-study basis to put the studies in the archive, and have the ability to pass forward those images to anywhere they are needed – have the ability to provide business continuity and even disaster recovery if needed," explains Jerry Edson, former CIO at Maine Medical Center and now a HealthInfoNet consultant.

HealthInfoNet already provides image reports, but with the new archiving system it will be able to offer up the images themselves. It’s "something providers have asked for and told us will better support their treatment decision-making," says Todd Rogow, director of information technology at HealthInfoNet.

The pilot will last through the summer, "to be sure you know that everybody can touch it, feel it. They can be confident that it’s working the way that it needs to work," says Edson. "In the fall, we will move from the initial participants of the pilot to the statewide rollout."

[See also: Maine receives grant to connect behavioral healthcare to HIE]

In addition to leveraging the HIE, the service prepares Maine’s providers for sharing images through the NwHIN Direct and Connect systems, Rogow notes. It also supports the development of accountable care organizations and other shared-risk models.

"As the concept of ACO starts to come into place," says Rogow, "a service like this fits very well and is very needed."
 
An estimated 1.8 million medical images (X-rays, mammograms, CT scans, MRIs etc.) are generated in Maine each year, totaling more than 45 terabytes of data. The organizations participating in the pilot generate 1.4 million of those images.

Today, the images are stored in a number of electronic archives at separate locations and mostly shared between non-affiliated providers by copying the images to CDs.

By consolidating the images into a single archive, HealthInfoNet estimates that Maine’s providers stand to save $6 million over seven years through reduced storage and transport costs.

"When a patient has an X-ray or MRI at a facility outside our system, it can take days for their doctor at Maine Medical Center, for example, to get a copy of that image," says Barry Blumenfeld, MD, CIO at MaineHealth. "This new service will save time for our providers and their patients. With instant access to a patient’s images, medical staff can treat them much faster and the patient won’t have to take the time to pick up and deliver CDs."
 
Officials note there are several additional benefits of having images stored in one place. First, easier access to past image studies should lead to fewer repeat tests, meaning less cost and less radiation exposure for patients. Also, HealthInfoNet will be able to link each image with a single patient identifier through its HIE Master Person Index, making it easier for providers to search for all of a patient's prior images when needed to track changes over time. For example, a radiologist wants to see all of a woman’s past mammograms, not just her most recent, to better detect changes in her breast tissue.
 
To build and operate the new cloud-based archive, HealthInfoNet selected Dell through a rigorous RFP process that involved vetting by both Maine clinicians and health information technology professionals. Dell manages one of the world’s largest cloud-based clinical archives through its Unified Clinical Archive solution, with more than 71 million clinical studies, nearly 5 billion diagnostic imaging objects and supporting more than 800 clinical sites.
 
HealthInfoNet, Dell and the pilot group of Maine healthcare organizations will work together over the summer to confirm the system design and integrate the service with existing PACS systems and the HIE. HealthInfoNet expects to end the pilot phase in the fall and expand the service statewide by 2013.

Besides making records readily accessible, says Jim Champagne, executive director, Dell Healthcare Services, Dell executives are proud that they were able to build a model that is self-sustainable financially.

"You don’t have to go out for a bunch of grants in order for that to be self-sustaining," he says. "We’re offering here to the providers not only the tools to exchange, but also a cost-effective archive and cost-effective disaster recovery solution around it that makes sense financially from cost of ownership.”

Dell has operates two data centers and one on the West Coast, where data is stored and managed.

Dell operates two data centers – one in Connecticut and one on the West Coast. Champagne says Dell has more than 10,000 interfaces to connect with the PACS in the marketplace today. Dell has worked with small regional facilities and IDNs that share information across multiple collaborative hospitals, "but nothing at the level that we’re seeing in this partnership across the entire state," says Champagne.

[See also: Maine practice celebrates its meaningful use status]

Hope for Health Reform? Push Single-Payer Now

It is unsettling to listen as President Obama and House Speaker Pelosi talk up a health-care reform “plan” that has yet to take shape in any realistic form.

The vagueness on the part of the president and the speaker is, of course, intentional.

Obama and Pelosi are still pushing the notion that they can get some version of their public-private stew cooked up before the year is done — although not, according to Senate Majority Leader Harry Reid, before the president and the Congress take the extended summer vacations that will kill whatever sense of official urgency might have existed.

Reid has taken some hits for suggesting that it would be a good idea to try and get health-care reform right, rather than just rush through a plan that fails to cover all Americans or control costs.

But that requires details. And neither Obama nor Pelosi is dealing in details right now because that’s where the devil resides.

Here is the truth they tend to avoid mentioning: A robust public plan, with the quality and flexibility that is required to make it appealing to all Americans, would wipe out its insurance-industry competitors in short order. Why would anyone opt for more of the profiteering, restrictions and actual denials of needed treatment — especially for people with pre-existing conditions — that the insurance industry uses to make money rather than provide Americans with the medical care they require? And why would any employer choose to subsidize the stock value of health-care conglomerates when it is possible to opt for the better care and controlled costs of a public plan?

Unfortunately, the creation of a robust public plan, one that can compete on the basis of quality and affordability, will require a significant federal expenditure in the form of start-up money as well as regulatory protection for the program. That’s where the devil comes in.

The powerful insurance and private health-care lobbies, which fear honest competition as the vampire does the stake, are going to do everything in their power to accomplish three things:

1. Scare Americans with hypocritical talk about the hefty price-tag for getting a robust public plan off the ground.

2. Undermine the structural supports for a public plan so that it cannot compete — effectively turning it into a sub-standard “alternative” that will appeal only to those who have no other options.

3. Fiddle with the overall “reform” so that most of the taxpayer money that is expended streams into the accounts of private firms.

In the state of confusion created the industry’s lobbying and advertising campaigns, chances are that the scaremongers and the profiteers will come out ahead.

They usually do.

And their task is being made easier by in-the-pocket “Democrats” like Montana Senator Max Baucus, the Senate Finance Committee chair who is collecting huge contributions from hospitals, insurers and medical interest groups in return for doing their dirty work. If it was just Baucus, that would be a problem.

But it’s not just Baucus. The monied Montanan has all too many Democratic allies — especially among the Democratic Leadership Council-allied “New Democrats.” The “New Dems” are far greedier and more troubling players than the small cadre of southern and rural Blue Dog Democrats. Of particular concern is the determination of so many of the “New Dems” to follow Baucus’ lead and grab up what Jerry Flanagan, a health-care analyst with the group Consumer Watchdog describes as the “huge down payment” of campaign contributions from corporations by that want any health care “reform” warped to favor their interests.

The corporate special interests and their willing accomplices within the ranks of the Democratic party are capitalizing on the confusion about the scope and character of proposed reforms. In so doing, they are creating a circumstance where the push for real reform can and will be thwarted unless there is a major pushback from real reformers.

That pushback can and should take the form of a renewed effort to promote the right repair: a single-payer program.

There has already been some progress in this regard. The recent 25-19 vote by the House Committee on Education and Labor for an amendment allowing states to create single-payer health care systems if they so choose was an example of this.

A bigger test could come this week, as the House Energy and Commerce Committee considers Congressman Anthony Weiner’s proposal to replace the convoluted public-private scheme that is outlined in the Obama/House leadership bill with the easily-understood and efficient single-payer plan contained in HR 676 that has been endorsed by 86 members of Congress.

Were the committee to endorse the Weiner amendment, single-payer would be on the table — as it should be.

Even if the committee fails to do the right thing, a strong vote for single-payer would send an essential signal about the need for a robust public option.

The stalwart single-payer backers at Progressive Democrats for America are organizing on behalf of the Weiner amendment, urging targeted calls to members of the committee.

The website www.democrats.com is maintaining a whip count, which includes phone numbers of members who are being targeted. Heading the list of those expected to cast “yes” votes for single-payer is Congresswomen Tammy Baldwin, D-Wisconsin, and Jan Schakowsky, D-Illinois, who has long been in the forefront of the real reformers in the House.

Baldwin and Schakowsky are staying steady.

And rightly so.

This is not the time to waver is our commitment to real reform.

Indeed, it is the time to press those who know the right reform to stop wavering.

Physicians for a National Health Care Plan has launched a smart — and necessary — new campaign to get President Obama to abandon experiments that are likely to fail in favor of the reform he supported before he became president: a single-payer plan.

“Like most of our colleagues and the majority of the general public, we believe that single-payer reform is the standard against which other health reforms should be measured. Sound single-payer proposals have been introduced in both the House of Representatives (H.R. 676, The U.S National Health Care Act) and the Senate (S. 703, The American Health Security Act of 2009),” the physicians write. “Single payer reform, as embodied in these bills, would eliminate the bewildering patchwork of private insurance plans with their exorbitant overhead and profits, as well as the costly paperwork burdens they impose on providers. These savings on bureaucracy – nearly $400 billion annually � are sufficient to cover all of the uninsured and to provide first dollar coverage for all Americans. No other approach can provide comparable coverage at a cost our nation can afford.”

That’s the proper prescription. Obama and Pelosi should listen to the doctors and follow it. But that will only happen if those who favor real reform seize on this uncertain but not unforgiving moment to make the case for single-payer.

10 physicians to follow on Twitter

Toward the end of last month, Mike Sevilla, MD, spoke to a crowd of 100 at the Connecting Healthcare + Social Media Conference on why physicians ought to be on social media. Although multiple such outlets exists — Facebook, Google+, LinkedIn — none have appealed quite so strongly to physicians as Twitter.

Here are 10 physicians, in no particular order, who have mastered the art of Twitter. 

1. Kevin Pho, MD – @kevinmd With approximately 53,000 followers, Kevin Pho, MD, tops our list of doctors to follow on Twitter. Pho blogs regularly at KevinMD.com and is on USA Today's board of contributors. He is consistently cited by major media outlets, and touts his blog as, "the Web's leading destination for proactive physician commentary on breaking medical news."

2. Mike Sevilla, MD – @drmikesevilla Formerly known as Dr. Anonymous, Sevilla tweets regularly and is the blogger behind FamilyMedicineRocks.com. He is known for being an advocate for physicians on social media, all while giving followers and blog readers a behind-the-scenes look at life as a family practitioner. He also hosts Family Medicine Rocks on Blog Talk Radio, where he reviews current industry events, news, and all things social media. 

3. Val Jones, MD – @drval Val Jones, MD, is a power tweeter and the founder behind Better Health, LLC, a network of 130 plus medical bloggers, which includes content partners like the Centers for Disease Control and Prevention, the American College of Physicians, and Harvard Health Publications. Jones is the "anchor blogger" behind the network. Previously, she was the author of "Dr. Val and the Voice of Reason," which won The Best New Medical Blog award, back in 2007. 

[See also: Social media being used as a platform to disclose illness.]

4. Tim Sturgill, MD – @SymTym Tim Sturgill, MD, is an emergency physician, manager, and director of social media at Emergency Medicine Physicians. He tweets regularly and has been blogging since 2004 at Symtym.com. Sturgill takes an active interest in not only emergency and disaster medicine, but also health law, policy and ethics, health informatics, and, most notably, social media. 

5. Bertalan Meskó, MD – @berci Bertalan Meskó, MD, tweets regularly and is a speaker, blogger, consultant, and founder of Webicina.com, a collection of curated social media resources. On ScienceRoll.com, Meskó blogs about his "journey in genetics PhD and medicine through Web 2.0," as well as the integration of medicine, web services, and social media. Meskó graduated from the University of Debrecen Medical School and Health Center in 2009 and maintains a Hungarian medical blog as well at MedIQ.blog.hu. 

6. Shelley Binkley, MD – @healthewoman Shelley Binkley, MD, tweets regularly and is an OBGYN advancing "healthEpeople." Binkley also founded HealthEwoman.org, where she writes brief articles on an array of topics pertaining to woman's health, making it easy for visitors to search and find quick answers to their questions. On HealthEwoman.org, Binkley makes clear she blogs for the sake of transparency and access, all while, as a physician, acting as a "sounding board to discuss [options] and together arrive at good medical decisions." 

7. Mark Browne, MD – @consultdoc Mark Browne, MD, is a physician consultant, focusing on bridging healthcare, quality, and finance. He tweets regularly and blogs at the Pershing Yoakley & Associates Healthcare Blog, Bridging Business & Healthcare. Browne is clinically trained in both internal medicine and pediatrics and has more than 10 years experience in physician practice management and hospital executive settings. 

[See also: Social media could 'accelerate clinical discovery'.]

8. Joseph Kim, MD – @DrJosephKim Joseph Kim, MD, is a physician executive and founder of MedicineandTechnology.com, NonClinicalJobs.com, MedicalSmartphones.com, and MobileHealthComputing.com. Kim has spoken nationally on topics pertaining to continuing medical education, mHealth, and social media. He is also the president of MCM Education, and he is a regular contributor to Physician Executive Journal. 

9. Jay Parkinson, MD – @jayparkinson Jay Parkinson, MD, is a pediatrician and preventive medicine specialist who tweets and blogs regularly at blog.JayParkinsonMD.com. He is also the founder of Hello Health, a combination of a secure social network and an EMR that enables doctors and patients to connect both in their office and online. Fast Company called Parkinson the "doctor of the future," and he was listed as one of the Top 10 Most Creative People in Health Care. Parkinson also recently launched a design firm, The Future Well. 

10. Mehmet Oz, MD – @DrOz Mehmet Oz, M.D. is a cardiac surgeon at New York Presbyterian Hospital, author and host of The Dr. Oz Show. He tweets regularly to more than 1,800,000 followers, and he blogs at DoctorOz.com. Oz has recently spoken on current business and technology challenges facing small physician practices. Oz also maintains his fan base on Twitter though the hashtags #OzTip and #OzApproved.

American Medical Assoc.: Require obesity education for kids

CHICAGO(AP)�The American Medical Association on Wednesday put its weight behind requiring yearly instruction aimed at preventing obesity for public schoolchildren and teens.

The nation's largest physicians group agreed to support legislation that would require classes in causes, consequences and prevention of obesity for first through 12th graders. Doctors will be encouraged to volunteer their time to help with that under the new policy adopted on the final day of the AMA's annual policymaking meeting.

Another new policy adopted Wednesday says the AMA supports the idea of using revenue from taxes on sugar-sweetened sodas as one way to help pay for obesity-fighting programs. But the group stopped short of fully endorsing such taxes.

Some doctors think soda taxes would disproportionately hurt the poor and disadvantaged. Others said taxes shouldn't be used to force people to make healthful decisions they should be making on their own.

Doctors at the meeting shared sobering statistics and personal stories in urging the AMA to sharpen its focus on obesity prevention.

"I can't tell you the number of 40-pound 1-year-olds I see every day," Dr. Melissa Garretson, a Stephensville, Texas pediatrician, told the delegates before Wednesday's vote. She said requiring obesity education "is a great idea."

The measure was drafted by the AMA's Pennsylvania delegation. It cited data showing that more than 300 million people worldwide are obese and said requiring nutrition education to prevent obesity has never been proposed.

Obesity affects more than one-third of U.S. adults and almost one in five children, or more than 12 million kids. Recent evidence suggests those numbers may have stabilized, but doctors say that's small consolation when so many people are still too fat.

Excess weight is strongly linked with diabetes, heart disease and some cancers, and weight loss of just 5 percent can help improve health, the Pennsylvania doctors' measure said.

Dr. Bruce Wilder, a delegation member, said he will ask Pennsylvania legislators to introduce legislation to enact that requirement in schools.

In other action at the meeting, the AMA voted to:

�urge online social networks to adopt bans on cyber-bullying, or "electronic aggression," on their sites.

�work to reduce suicide among gay, lesbian, bisexual and transgender teens by partnering with public health and policy groups addressing the problem.

�encourage state and local drug courts as an alternative to incarceration for nonviolent criminals.

Health information laws made clear on new GWU website

WASHINGTON – A new website, which clarifies federal and state laws pertaining to health information, developed by researchers at The George Washington University's Hirsh Health Law and Policy Program, launched Wednesday.

The website, Health Information and the Law (HealthInfoLaw.org), serves as an online resource where organizations, consumers and healthcare providers alike can find a clear, comprehensible picture of current health information laws, policy changes and legislation.

[See also: RWJF launches new site with quality info on doctors, hospitals]

HealthInfoLaw.org, a Legal Barriers project funded by the Robert Wood Johnson Foundation, offers a lucid list and comparative analysis of regulations and laws relating to health information exchange, the shift to EMRs, confidentiality, HITECH, the ACA and HIPAA, to name a few.

“The laws are very opaque to a lot of people and difficult to navigate, and we wanted to create a resource that would translate laws themselves and complicated issues for people on the ground who are trying navigate them," says Lara Cartwright-Smith, co-director of the Legal Barriers project and assistant research professor in the GW Department of Health Policy.

The project has "a multi-aim," says Jane Hyatt Thorpe, also a co-director of the Legal Barriers project and associate research professor at the GW Department of Health Policy. "We’re hoping to help the activities going on at the local, regional and state level in terms of community organizations and other organizations working to transform care delivery.”

[See also: HIE on the upswing]

Cartwright-Smith adds, “We don’t want to limit the audience.” The audience may consist of “policymakers; it might be individual providers, consumers or organizations trying to implement health reforms and need to know the laws pertaining to them.”

Sara Rosenbaum, Harold and Jane Hirsh Professor of Health Law and Policy at GWU School of Public Health and Health Services explained in a news release why the website is so significant today:

"Health information law exists at the intersection of many crucial and related fields: law, healthcare, public health, market competition, consumer protection, information technology, and health insurance." she said. "A modest change in any of these fields can trigger a daunting set of issues and challenges. HealthInfoLaw.org offers keys to understanding the laws that govern health information and their implications for health care, consumer rights and population health." 

Corporate Media Have Ruined the Health Care Debate

TV networks have shut out coverage of single-payer as an option for health reform. We must work to get it back in public debate.

The debate about health reform is clearly in critical condition, with the prospects for President Barack Obama’s proposed “public option” looking increasingly uncertain. The U.S. is the only industrialized nation where insurance for primary healthcare is largely in the hands of private corporations, but despite overwhelming public support for a greater government role in health insurance, pundits are now advising us that even Obama�s modest proposal of making private insurance corporations compete with a public insurance fund may have to be scrapped.

Sen. Max Baucus (D.-Mont.) — the politician who played one of the most powerful roles in shaping this debate — would seem at first blush an unlikely man to diagnose the ailments afflicting our health reform debate.

After all, many people will recall that when several doctors asked at a recent Senate hearing why “Medicare-for-all” — a reform option that many citizens and healthcare professionals see as the best tool for fixing healthcare — was not on the table, Baucus responded by asking for more police.

Yet as the NYT reported, Baucus has since:

Conceded that it was a mistake to rule out a fully government-run health system, or a �single-payer plan,� not because he supports it but because doing so alienated a large, vocal constituency and left Mr. Obama�s proposal of a public health plan to compete with private insurers as the most liberal position.

After all, what better way to diffuse the fearmongering about Obama�s plan being a “Trojan horse” for the right�s favorite boogeyman — “socialized” medicine — than provide the public with accurate information on Medicare-for-all and its benefits? After all, a single public fund that would provide all Americans with healthcare coverage, much like Medicare currently provides for seniors, is seen by many experts as the most effective way of achieving the goals of healthcare reform: reducing costs while expanding coverage.

What better way to counter the pundits� insistence that Obama “compromise” with industry-backed politicians than by pointing out that the “public option” is already a serious compromise, given that most citizens and physicians actually favor “single-payer� — a more comprehensive and progressive option. After all, a recent New York Times/CBS poll (1/11-15/09) found that 59 percent of respondents said they would prefer that”the government in Washington provide national health insurance,” rather than leaving health insurance to private industry. Meanwhile a recent survey (Annals of Internal Medicine, 4/1/08) found that 59 percent of physicians also support single-payer.

Of course, the insurance lobbies and many politicians have never wanted to talk about single-payer.

Continue…

Blind movie critic Tommy Edison educates the masses

Tommy Edison knows you've got questions about blind people � because people have been asking him those questions all his life.

Like: Do you see stuff in your dreams?

And: How do you count your paper money?

And: Do you think you could hit a golf ball?

Actually, that last one was a question Edison had and decided to answer, along with the others, in a online video series he calls "The Tommy Edison Experience." The videos are shot and edited by his buddy Ben Churchill, a documentary filmmaker, and share a website with a series called "Blind Film Critic."

Yes, a blind guy reviews movies. In fact, Edison � who works as a traffic reporter for a Connecticut radio station � became mildly famous for his pithy reviews about a year ago. His web traffic spiked after master critic Roger Ebert mentioned him online, Edison says.

With the attention, came the questions �starting with how a blind man can appreciate movies.

"I like strong characters in a good story and I like a few laughs," Edison says in a phone interview. Lots of dialogue helps.

But in between going to movies and reporting on traffic tie-ups (using police scanners and calls from listeners), Edison is just a regular forty-something guy who has been blind since birth. The point of the "experience" videos, he says, is "to show sighted people how I live and how I do things," educate a bit and have some fun.

So Edison has answered questions about his:

�Dreams: "I don't see in my dreams. It's all smell, sound, taste and touch," he says.

�Money: In one video, he buys a beer and has to ask the cashier to name the bills as he takes his change so he can line them up in order. Every blind person needs a system, he explains, because U.S. paper currency is not differentiated in a way blind people can detect (though it soon will be, say advocacy groups for the blind).

�Golf game: It's pretty good - for a blind guy. (He hits a ball after a few lessons).

�Travel style: He's an able-bodied guy, but has to explain to an airport employee (repeatedly, with impressive good humor and politeness) that he doesn't need a wheelchair to get through a terminal.

�Celebrity curiosity: If he could see three celebrities, he'd choose singer Tom Waits ("I've got to see the face that goes with that voice"); actress Angelina Jolie ("I keep hearing how beautiful she is") and Jay Leno ("the devil himself," says the Conan O'Brien fan). He's also curious about the Muppets.

Edison doesn't speak for all blind people. But it's nice to have someone out there answering the kinds of questions many blind people get all the time, says Eric Bridges, director of advocacy at American Council of the Blind. "People are naturally curious," he says. "And humor is the greatest device to sort of cut the tension and put people at ease."

The videos seem "very positive and informative," says Chris Danielsen, director of public relations at the National Federation of the Blind. Social media creates opportunities for many blind people "to get our own stories out," he says.

For Edison, that means sharing his reviews of Cabin in the Woods and The Hunger Games (he didn't love either) and answering the question: "Can you open your eyes?" The answer, as he demonstrates in one video, is yes, he can. "Next time," he promises, "I'm going to show you how I perform surgery."

mHealth: Embraced by developing world, resisted by developed countries

NEW YORK – A new study of the global mHealth market finds that consumers and developing countries are driving its growth, while physicians are reluctant to adapt.

Those are some of the conclusions drawn from “Emerging Health: Paths for Growth,” published by PricewaterhouseCoopers. The 48-page report, based on two separate surveys conducted by the Economist Intelligence Unit and analyzing 10 nations, indicates developing nations are quicker to accept and adopt telehealth because it’s seen as a way to increase access to healthcare, while developed nations like the United States are being dogged down by regulatory hurdles and a resistance to change among providers.

[See also: Doctor or patient? Who will drive mHealth?]

“Consumers are demanding and payers are willing to pay, but providers aren’t willing to provide,” said Christopher Wasden, PwC’s global healthcare innovation leader. “What we are going to need to do is get providers to think and act differently.”

“To what extent are physicians in their country willing to adapt?” he asked.

Wasden and David Levy, MD, also a global healthcare leader for PwC, said mHealth is more of a disruptive force in developed nations because it challenges the status quo and forces providers and payers to accept that patients have more control of their healthcare choices. Wasden said many doctors are wary of giving the patient more access to medical data and control because they fear – incorrectly – that they will lose business.

[See also: New report offers insight into fragmented mHealth market]

In developing countries, meanwhile, mHealth is seen as a new market with exciting possibilities. New startups and business models, with assistance from the telecommunications sector, Wasden said, are driving mHealth to unprecedented levels of growth. That, he said, is why the African nations and India are among the hotbeds for new innovation in mHealth.

In developed nations, meanwhile, providers – and to a lesser extent payers – say there are too many barriers to mHealth. More than one-quarter of those surveyed in both categories say the conservative culture in healthcare is a leading barrier; others include complex regulations and technology, lack of access to wireless services; and massive changes to the physician’s workload.

Nearly half of the patients surveyed, meanwhile, indicate that in the next three years, mHealth will improve the convenience (46 percent), cost (52 percent) and quality (48 percent) of their healthcare.

“Despite demand and the obvious potential benefits of mHealth, rapid adoption is not occurring,” Levy said. “The main barriers are not the technology but rather systemic to healthcare and inherent resistance to change. Though many people think mobile health will be ancillary or bolted on to the healthcare industry, we look at it differently: mHealth is the future of healthcare, deeply integrated into delivery that will be better, faster, less expensive and far more consumer-focused.”

While physicians are wary of the empowered patient (the report indicates 42 percent of doctors surveyed worry that mHealth will make their patients too independent), Wasden said they “completely miss” the benefits of instant access to healthcare data. He said healthcare costs can be brought down if patients change their behaviors, and that can be accomplished if they work with physicians and use real-time data to monitor and manage their lifestyles.

“We know what will really change patient outcomes … but physicians don’t believe they can change patient behaviors,” he said.

According to the report, only 27 percent of physicians encourage patients to use mHealth to become more active in managing their health, while 13 percent actually discourage it.

Wasden said the popular perception that payers are opposing mHealth in the United States is wrong. The report indicates 40 percent of payers surveyed encourage patients to let doctors monitor their health and activities and to use mHealth (compared to only 25 percent of physicians). Payers, he said, are feeling threatened by healthcare reform, and are adopting new technologies like mHealth in order to adapt to the changing healthcare landscape. They’re supporting measures that allow patients to be treated in their homes and in clinics – anywhere but the hospital, which he said is the “most expensive place to treat a patient.”

That doesn’t mean hospitals should fear mHealth. Wasden said America’s broken healthcare system – and the healthcare systems of many developed nations – are suffering because 30 percent to 50 percent of the patients in hospitals don’t need to be there, thus causing overcrowding and waste. Taking that percentage out of the hospitals, he said, reduces healthcare costs dramatically and frees up hospitals to treat only those who should be treated there.

Wasden said the PwC report points out that mHealth adoption will take time and effort. Eventually, he said, what’s called “mHealth” will evolve into “healthcare.”

“We need to be realistic that we are in the very early stages,” he said.

A full copy of the report is available for download here.

[See also: mHealth moving forward fast, experts say]

Independent Grades For Hospitals Show Quality Could Be Better

iStockphoto.com

Hospitals that muff patient safety avoided F's for now, but a new independent grading system will hand those out before long.

The cities of New York and Los Angeles grade their restaurants on cleanliness and the precautions they take to avoid making customers sick.

Now hospitals are getting similar assessments for their patient safety records from the Leapfrog Group, a nonprofit that's looking to improve the quality and safety of health care.

For 2,651 hospitals, Leapfrog created a single letter grade from 26 different measures collected by Leapfrog or Medicare. They included hospitals' adherence to safe practices, such as entering physician orders into computer records to avoid penmanship errors and removing catheters promptly to minimize the risk of infections. The grade was also based on hospitals' records of mishaps, such as bed sores, infections and punctured lungs.

Leapfrog gave 729 hospitals an A grade, 679 hospitals a B and 1,111 hospitals a C. Another 132 hospitals were scored "Grade Pending," Leapfrog's euphemism for below a C.

 

Leapfrog plans to introduce D's and F's when it updates the ratings in six months, but didn't want to be too harsh in its first report, said Leah Binder, Leapfrog's executive director.

"We designed this to capture the attention of the public," Binder said. "No one has ever given one individual score to most of the general hospitals in the country, including those that didn't perform well." Ratings can be found at Hospitalsafetyscore.org, but the site was hard to access Wednesday morning, apparently everyone wanted to see it at once.

The American Hospital Association disputed Leapfrog's ratings, saying in a statement that it "has supported several good quality measures but many of the measures Leapfrog uses to grade hospitals are flawed, and they do not accurately portray a picture of the safety efforts made by hospitals."

Among the mediocre performers in Leapfrog's study are some well-respected names. New York-Presbyterian Hospital in Manhattan and the Cleveland Clinic Hospital both got C's. UCLA Ronald Reagan in Los Angeles got a "Grade Pending." Leapfrog gave A's to some other well-known places such as the Mayo Clinic in Rochester, Minn., and Cedars-Sinai Medical Center in Los Angeles, and also to a host of obscure community hospitals.

"The hospitals that achieved an A came from all walks of life, across the gamut of hospital types and people they serve," Binder said. "Safety appears to be something that all hospitals can choose."

Massachusetts, Maine and Vermont were the only three states where half of the hospitals or more got a grade of A. In 24 states and the District of Columbia, half or more of the hospitals got a C or "Grade Pending." The worst performers were the District, Oregon and New York , where at least two-thirds of the hospitals got a C or lower. Kaiser Health News has a sortable chart of the grades by state here.

Hospital officials raised a number of objections. Dr. Michael Henderson, chief quality officer at the Cleveland Clinic, noted that much of the data was a year or two old, and many hospitals have made significant strides since then. "The question the public needs to be asking is, 'Are you working on this? Are you getting better?' " he said.

Leapfrog's information comes from two sources: its own surveys of hospitals that agree to participate, and data the Centers for Medicare & Medicaid Services culls from its billing records and posts on its Hospital Compare website.

Dr. Shannon Phillips, a quality and safety officer at the Cleveland Clinic, said that the way Leapfrog calculated its grades, "you are automatically at a deficit if you did not participate in their survey." The clinic, like some other hospitals, dropped out of Leapfrog's surveys in recent years as the government began requiring more and more information to be provided to it for publication.

Binder, however, said that the way the scores were calculated wouldn't disadvantage hospitals that didn't partake in Leapfrog's survey.

Leapfrog, which is based in Washington, said it consulted with nine nationally known experts, including Dr. Peter Pronovost of Johns Hopkins, Dr. Patrick Romano of University of California, Davis and Dr. Ashish Jha of the Harvard School of Public Health, in designing the letter grade scoring methods.

Jha called Leapfrog's grades "a really important step forward," because they simplify complex measurements into things that consumers can easily understand and digest. Numerous studies have found that consumers rarely use complex quality measurements when choosing hospitals, blunting the potential influence of resources like Hospital Compare.

"As better data comes along and as time goes by, my hope is this grading will get refined," Jha said.

Unlike a city public health department, Leapfrog can't post its grades on the front doors of a hospital. Binder said Leapfrog hopes that groups of employers that purchase insurance will disseminate the ratings to workers and use them when selecting health care providers.