Surrounded by men and women who made their careers killing healthcare reform, President Obama reiterated his pledge to enact comprehensive legislation this year during a White House summit launching his effort to treat the nation's ailing health system. Words of support came from lobbyists for physicians, drugmakers, and the corporate sector during the summit, where Obama made the case that it is possible to expand health coverage in America while bringing soaring medical bills under control.
Sanjay Gupta, MD, a neurosurgeon and CNN's chief medical correspondent, has withdrawn his name from consideration as surgeon general of the United States. Gupta said he would likely have had to give up practicing had he taken the job. In addition, the 39-year-old and his wife are expecting their third daughter any time, and the government job would have meant long periods away from his family, he said. Gupta said that although he had not been formally nominated, he had spoken with senior members of the Obama administration who made it clear he was their choice.
President Barack Obama on Thursday told key stakeholders in the healthcare reform debate that there should be no "sacred cows" in the discussion on healthcare reform, which he said will require sacrifices from everyone involved to address the "exploding cost of healthcare in America today."
"Healthcare reform is no longer just a moral imperative, it is a fiscal imperative," Obama said, in opening remarks at the White House summit on healthcare. "If we want to create jobs and rebuild our economy, then we have to address the crushing cost of healthcare this year, in this administration. Making investments in reform now, investments that will dramatically lower costs, won't add to our budget deficits in the long-term—rather, it is one of the best ways—in fact maybe the only way to reduce those long term costs."
Obama told the group that he wants to sign a healthcare reform bill this year and that every idea will be considered. "There should be no sacred cows. Each of us must accept that none of us will get everything we want, and no proposal for reform will be perfect. If that is the measure, we will never get anything done," he says. "But when it comes to addressing our healthcare challenge, we can no longer let the perfect be the enemy of the essential."
He also warned against anyone who would attempt to sabotage or delay the reforms. "While everyone has a right to take part in this discussion, no one has the right to take it over. The status quo is the one option that is not on the table," he said. "Those who seek to block any reform at any cost will not prevail this time around. I did not come here to Washington to work for those interests."
Melody Barnes, director of the White House Domestic Policy Council, said the president came to the summit with no set plan for healthcare reform beyond a set of parameters. "He knows that we have to get costs down. He believes that we have to have a quality healthcare system that is accessible and affordable for everyone," she told C-SPAN. "At the same time, he is being very pragmatic about this. He wants to bring people around the table to hear what they have to say. Then we can start to work together with Congress to make sure we get the policy right."
The president included a $634 billion "down payment" over 10 years for healthcare reforms that could total more than $1 trillion in the budget he sent to Congress last week. "We know that is not enough to take care of the huge problem, but we are going to work with Congress to see how we can get the rest of the revenues or cost savings to afford the healthcare system the American people deserve, and at the same time work on the policy of healthcare reform," Barnes said.
Barnes reiterated that the president expects Congress to draft the healthcare legislation, not the White House, which she noted was a key difference between the Obama administration's efforts and President Bill Clinton's failed healthcare reforms of 16 years ago. "We are not going to Congress with a preset plan. We are open to what they have to say," Barnes says. "We are having a conversation with Congress and we are going to work with them as they write the bill."
Barnes says today's summit also demonstrates that Obama is committed to a transparent process. "Today the American people will be able to go to their television sets, they will be able to go to our Web site and listen to what the president and all the people in the room have to say," she says.
American Hospital Association President Richard J. Umbdenstock, who attended today's summit, said he told President Obama at last week's fiscal responsibility summit that the nation's hospitals will answer his call for "shared responsibility" as long as everybody else does too.
"We believe we have to be part of the solution, but so do vendors, suppliers, other providers, employers, and consumers themselves. It's not going to be solved by one approach or putting it on the shoulders of any one stakeholder," Umbdenstock told HealthLeaders Media.
"Hospitals are the ones that hold this somewhat broken and disjointed system together on Main Street day in and day out for America's communities and patients in need," he says. "We are calling for reform, but not just in the form of short-term payment cuts and reductions, that will just force the system to get more out of kilter and out of balance than it already is."
While the president has said he will consider every option, apparently, single-payer is off the table. Barnes said the president is not interested in a single-payer healthcare system. "The president believes that we have to build on the system that we have right now. He's said that maybe if we were starting from scratch that is what we'd do, but that isn't where we are," she said.
John Comminsis the human resources and community and rural hospitals editor with HealthLeaders Media. He can be reached atjcommins@healthleadersmedia.com.
Although the benefits of EMR technology are well documented, going paperless is a complicated process that changes the way physicians and staff members handle almost every task. But proper training and preparation can make for a smooth transition.
The transition can be complicated if a practice does not allow enough time for the process, says Denise Moore, business administrator at Physicians to Women, PA, in Stuart, FL. She recommends one year, if possible, or no less than six months of training and preparation for going paperless.
Major problems can arise when the practice has not analyzed and delegated proper work flow. This can result in bottlenecks in the work flow process, Stearns says.
Another potential problem is when the doctors of a multi-physician practice do not want to change how they organize information on patient records. Having a written work flow process can alleviate this situation, Moore says.
Some staff members learn differently than others. The amount of training necessary for staff members depends on their computer experience and learning preferences. For example, some people learn more quickly by following a written manual and require more of a learning curve.
Others are visual learners and only want the manual as a reference guide and, as a result, may learn the system more quickly, Moore says.
It is also important to remember that mistakes can still be made with an EMR system. The wrong information can be scanned into a chart, much like someone misfiling a paper chart. Again, proper training, as well as emphasizing meticulously entering patient information, can help avoid this problem.
This article was adapted from one that originally ran in the March 2009 issue ofThe Doctor's Office, a HealthLeaders Media publication.
Sometime in the not-too-distant future, the vast majority of health records will be electronic. I am sold on the benefits of EMR systems and I am a proponent of physician adoption when possible. Even if I weren't, however, I'd recognize that forces are pushing healthcare in that direction and physicians can only lag behind for so long.
So when President Obama signed the economic stimulus bill a couple of weeks ago, I suggested that, with incentives to offset the costs of adoption on the way, it was time for physicians to prepare for the switch.
Not everyone agreed, however. And because I don't work in a practice environment and am not as familiar with some of the operational hassles and implementation obstacles, I want to give the counterpoints plenty of consideration.
As it has always been, the cost of implementation seems to be the hang-up. Reader Michael J. Patti, MD, considers himself a proponent of EMRs, but doesn't see how the incentive plan as it is structured will help physicians in the short-term.
"The economy has tanked, credit is not available ... and the revenue stream in a private practice primary care office has been flat for years. Now one more loan is supposed to be taken out, (if you can get it) on the promise that the check will be in the mail in a few years," he says. "This does not help me buy an EMR now."
An administrator for a cardiology practice in Arizona thinks the nearly $42,000 in incentives in the stimulus package grossly underestimates the true costs of implementation.
"Our cardiology practice of seven doctors and six nurse practitioners just went live on EMR in June 2008," she says. "For a group of our size and specialty with three office locations and four hospitals, thousands of patients and numerous interfaces and additional testing modalities, the cost is well in excess of the $42,000 per provider amount. The scanning of documents alone cost our practice $138,000."
Further complicating the math, James J. Schneider, senior associate dean for Finance & Administration at Marshall University's Joan C. Edwards School of Medicine and executive director of University Physicians & Surgeons, Inc., argues that practices have to consider whether the incentive money is truly a net positive for the practice or just a shifting of funds from other reimbursement areas.
"While the stimulus bill is a powerful financial incentive for those who haven't yet adopted an EHR, investing $30,000 or more per physician in the hope that Medicare's yet to be drafted regulations will present an attainable ROI four or more years down the road is still a pretty 'iffy' proposition," he says. "Plus, there are enough SGR-based physician fee reductions built into Medicare's future projections to more than offset the EHR incentive. With the President and a Democratic Congress battling trillion-dollar-plus deficits as far as the eye can see, physicians likely will not be at the top of anyone's list for future Medicare budget relief."
So what's the final verdict? Is the lingering skepticism justified? Will the stimulus package really accomplish its goals, or are we destined to inch toward EMR adoption for years to come?
Ultimately, the monies' effectiveness depends on yet-to-be-announced details. Patti pointed out that the government still has to outline what qualifies as "meaningful" EMR usage, and as I mentioned in a previous column, the scope of approved systems will greatly determine interoperability and the level of innovation we see from EMR vendors.
Still, many practice leaders believe they cannot afford EMR implementation, even with the stimulus incentives. But for me, the math comes out the same, primarily because of the time line physicians are facing: By 2015, Medicare will start reducing reimbursement rates for providers who are not meaningful EMR users.
Soon, physicians won't be able to afford to not have EHR.
Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at ebakhtiari@healthleadersmedia.com.
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It's easy to see how Mike Huckabee's personal health history has influenced his views about healthcare policy. The former Arkansas governor addressed AMGA attendees during a networking lunch on the conference's last day, and although he seemed comfortable reciting a wide range of health statistics from memory, the story of how he turned his health around after being diagnosed with Type II diabetes was the most compelling part of his speech.
When Huckabee's doctor told him in 2003 that he was entering the "last decade of his life" if he didn't improve his health, he took it to heart—he began exercising and eating healthier foods and was able to lose 110 pounds and eventually run four marathons.
And now Huckabee sees his former problem as one of America's biggest long-term threats. We're not facing a healthcare crisis, but a health crisis, he told AMGA attendees. He pointed to a growing obesity problem and rising rates of childhood diabetes. He chastised politicians for looking for four- or eight-year policy solutions when what is needed is a cultural shift in how Americans take individual responsibility for their own health, which he said could take a generation.
He cited cultural shifts in how Americans changed their views on littering, seatbelts, smoking, and drunk driving as evidence that finding solutions to the obesity epidemic is possible. And some of the programs he implemented as governor of Arkansas, such as paying for 100% of smoking cessation programs and rewarding employees who improve their health, provided examples of effective wellness incentives.
Some of what he advocated, such as the need for more prevention, fit in nicely with what most healthcare experts agree on. But parts of his speech almost contradicted earlier presentations, including the opening keynote—his conclusion that the United States has the best healthcare system in the world didn't jibe with IHI President Donald Berwick's data suggesting U.S. healthcare lags behind most industrialized nations but costs twice as much.
In fact, Huckabee barely mentioned some of the more detailed topics central the current healthcare reform discussion, such as how to cope with the number of uninsured, how to handle provider shortages, and whether or not the healthcare provisions in the economic stimulus package were worthwhile.
Huckabee is by no means a healthcare policy wonk and left many gaps in his handling of the system, but his vision for a healthier America is an important part of the equation that shouldn't be overlooked in reform efforts.
Many might disagree with his assertion that we're facing a health crisis rather than a healthcare crisis, however. For most physicians and hospital leaders, it's both.