While there was no surprise over the Supreme Court's decision Monday to review the 2010 health-care act's insurance mandate, supporters of the law are reeling over the justices' announcement that they will also consider a long-shot challenge to what many consider an even more central provision of the statute. That provision is the extension of Medicaid to cover a greater number of the poor. Twenty-six states say the expansion amounts to an unconstitutional coercion of state governments, which provide part of Medicaid's funding. "The decision on this issue is probably the most important the Supreme Court will be making on the Affordable Care Act," said Ronald Pollack, executive director of Families USA, a consumer advocacy group that backs the law, referring to the statute by a common shorthand.
At Home and Hospice Care of Rhode Island, where she's a medical director, Joan Teno, MD, has grown accustomed to patients being admitted with no clear understanding of their condition or prognosis. "The oncologist has told them, 'It's time to take a holiday from chemo,'" she said. "It's a way not to have a conversation he or she finds hard to do." So the hospice staff has to explain, compassionately but directly, what the physician didn't say: that chemotherapy isn't working. That the cancer isn't curable or effectively treatable. That death is near. Is this too scary a discussion? Too apt to cause the patient grief or fear, or torpedo the family's hopes? A Swedish study of patients with terminal cancer, just published in The Journal of Clinical Oncology, provides a solid argument to the contrary.
Discussions about MetroHealth Medical Center taking over medical services at the Cuyahoga County Jail have taken a turn, with both sides near an agreement calling for the hospital to provide temporary staff and other support while the county moves to hire its own doctors. For much of the year, officials of the new county government have sought to have the county-owned hospital system handle medical care at the high-rise jail, which houses more than 2,000 inmates. MetroHealth argued that it does not have expertise in correctional medicine. But executives had told The Plain Dealer in June they expected to have an agreement by July to take over medical services.
The Centers for Medicare and Medicaid Services (CMS) will award up to $1 billion in grants for ideas that can deliver quick benefits to the Medicare program in terms of cost savings and higher-quality care. The program, funded by the 2010 Patient Protection and Affordable Care Act, will provide three-year grants of $1 million to $30 million--potentially hundreds of awards--to healthcare providers, payers, local government entities, and public-private partnerships, including collaborative efforts among multiple payers.
As the importance of exchanging patient data through health information exchanges grows, the College of Healthcare Information Management Executives (CHIME) and the eHealth Initiative have released a guide that offers practical assistance on measures to successfully implement these exchanges. The HIE Guide for CIOs is a Web-based tool that executives at CHIME and eHI hope will be used to help healthcare organizations demonstrate one of the core requirements of Stage 1 Meaningful Use, which is to electronically exchange key clinical information among providers of care and patient authorized entities.
Regional health IT extension centers have signed up more than 100,000 physicians, or one third of all primary care providers in the nation, to help them deploy electronic health records, reaching its goal slightly ahead of its yearend schedule. And 70% of all primary care providers in small practices in rural areas around the country are working with the extension centers, and in some states, it's practically 100%, said Farzad Mostashari, MD, the national health IT coordinator. Those are among the efforts through which the Office of the National Coordinator for Health IT's toolbox has established a beachhead, he said at a Nov. 17 summit spotlighting the progress of the extension centers, health information exchange, and beacon or model health IT communities to help to transform healthcare.