A Colorado bill has won initial House approval to expand health coverage by imposing a fee on hospitals. House Bill 1293 would generate an estimated $600 million. That money would draw an equal amount in federal matching funds, and the $1.2 billion total could be used to expand coverage for Medicaid, the state's Child Health Plan Plus, and indigent care programs to at least 100,000 more Coloradans.
Fitch Ratings assigned an AA- underlying rating on the expected issuance of about $200 million in bonds on behalf of Florida-based BayCare Health System. Proceeds from the bonds will be used to refund about $154 million of outstanding auction-rate bonds issues in 2006 to provide $40 million to end a floating-to-fixed-rate swap on the 2006 bonds and to cover the cost of issuance, Fitch said in a release.
Fewer than 1,000 people have signed up for healthcare coverage under the Cover Florida program. Gov. Charlie Crist said in a release that six health plans reported enrolling 952 Floridians in the first two months of the program, from Jan. 1 through Feb. 28. Eighty-two percent of those who enrolled chose catastrophic coverage and 18% chose preventive coverage, the release said.
The federal agency responsible for investigating Medicare fraud and other health law violations, and whose probe of Towson, MD-based St. Joseph Medical Center led to a leadership shake-up last month, has ordered a group of cardiology specialists affiliated with the hospital to hand over business records. Midatlantic Cardiovascular Associates, a dominant cardiology practice at hospitals in the Baltimore area, received a subpoena from the Department of Health and Human Services in June—the month the agency made a similar demand of St. Joseph, documents show.
President Obama sought to reassure Americans that his administration has made progress in reviving the economy and said his $3.6 trillion budget is "inseparable from this recovery."
During a 55-minute news conference, the president focused consistently on his administration's efforts to boost the economy, presenting his first budget proposal as the critical and most far-reaching step in that process.
Rates for many health-insurance plans are going up again this year in Washington state. Already, four Washington carriers have filed rate hikes for individual plans for 2009. Premera Blue Cross will see a 6.1% increase for individuals this June, while its affiliate, LifeWise Health Plan of Washington, had a rate increase of 17.6% in January. Group Health Cooperative also expects to raise its rates.
Armed with new data showing that the cost of health insurance in Texas is soaring seven times faster than incomes, the Texas Hospital Association and the National Federation of Independent Business/Texas pushed lawmakers to pass bills aimed at making healthcare more affordable and accessible. The Texas hospital and small-business groups voiced support for 25 bills that have been introduced this legislative session. Of those, five seek to restructure the state's high-risk insurance pool, which was created for people unable to qualify for Medicaid or Medicare or to secure private insurance.
New Jersey's physician shortage will worsen unless an $8 million budget cut to teaching hospitals is restored, a doctor told the Assembly Budget Committee. J. Richard Goldstein, MD, president of the New Jersey Council of Teaching Hospitals, which represents 10 institutions, was among the first to testify at budget hearings.
He said the proposed budget cut to teaching hospitals effectively eliminates funding for 69 medical residents. Goldstein said New Jersey is projected to have 2,800 fewer doctors than the 27,500 it will need in 10 years, and that shortage will be worse if there are aid cuts.
Boston-based Beth Israel Deaconess Medical Center will lay off 140 or fewer employees, using a combination of delayed raises, a temporary reduction in benefits, and donations from department heads to avoid wider job losses. Paul Levy, the hospital's chief executive, revealed the decision in an e-mail message to staff that he posted on his blog. The move follows weeks of meetings and online discussions seeking ways to preserve many of the 600 jobs initially endangered by a $20 million budget shortfall.
The industry has seen serious momentum in the health IT field since President Obama took office in January. However, physician resistance toward adopting "clunky" electronic medical records remains strong, and experts say swaying physicians will likely be one of the greatest challenges for David Blumenthal, MD, the newly-named national coordinator for health information technology.
In an industry survey released this month, the American College of Physician Executives found that while health IT adoption is up more than 64% since 2004, physicians' opinions of IT are not. (One survey respondent summed up physician resistance by calling his adoption of electronic medical records the "worst aspect of my 25 years in medicine.")
So what's the problem? First and foremost, money. Nearly 41% of the 1,000 physicians surveyed say funding is their primary adoption obstacle. The government's plan to spend $19 billion (or about $44,000 per physician) on digitizing America's health information could answer some questions about IT costs. It does little, however, to address doctors' other concerns, including lack of support or buy-in from physicians and other medical staff (19.6% in the ACPE report) and difficulty integrating with existing or other computer systems (11.9%).
Most of the physicians' complaints haven't changed much in the past five years. "While the technology may be more advanced, it still prompted plenty of grumbling. The respondents said the systems were still too clunky, too hard to use and just too poorly developed," writes Carrie Weimar, director of public relations at the ACPE.
While Blumenthal is a recognized health IT policy expert, he also has an extensive clinical background, giving him better perspective into the practical problems doctors face when they go electronic, experts say. He demonstrates that perspective in a 2007 New England Journal of Medicine article he co-wrote with Jonathan Glaser, CIO at Partners HealthCare, called "Information Technology Comes to Medicine."
"The idea of health IT transports some enthusiasts to almost a dreamlike world of healthcare perfection in which the work of doctors and the care of patients proceed with barely imaginable quality and efficiency," they wrote. "But for many doctors, especially those in solo or small practices, it conjures a very different image—that of a waiting room full to bursting, a crashed computer, and a frantic clinician on hold with IT support in Bangalore."
It's that level of understanding that has many peer physicians and vendors standing behind Obama's choice in HIT leadership. "I am delighted. I think that in this phase of the HIT movement, what we need to see is a care-centric versus technology-centric approach. Blumenthal is widely hailed as an expert clinician. Because of that I think he'll have a unique understanding of how to use HIT to make care better, rather than using HIT for the sake of using HIT," says Peter Basch, MD, medical director for ambulatory clinical systems at MedStar Health, based in Columbia, MD.
Basch says he hopes that among Blumenthal's top priorities is defining or appointing a body to clarify the "meaningful use" portion of the stimulus package. "I like the inclusion of meaningful use as a stipulation for the stimulus incentives because I've never believed adoption of technology by itself is enough to make care better," says Basch. "Yes, there has to be a change in the way medicine is practiced by making better use of technology, but in order to overcome some of that resistance, there has to be a change in the way physicians are compensated too. I think Blumenthal is someone who can recognize that."
Joel Diamond, MD, chief medical officer at dbMotion and a practicing physician at University of Pittsburgh Medical Center and the Handelsman Family Practice in Pittsburgh, PA, says he expects Blumenthal will face some of the same obstacles as his predecessors when it comes to aligning physician incentives. Diamond says that primary care physicians have borne the brunt of previous attempts to reform healthcare by having reimbursement levels and work-flow disrupted. Efforts must be directed to improving all of these areas in order to make real change, he says.
As for physician complaints about EMRs and other HIT being clunky and slowing workflow, as reported in the ACPE study, Basch says those complaints could be minimized by reforming the payment system. "Maybe slowing down is not such a terrible thing. The reason physicians complain is that they aren't paid any differently. If we had a payment system that rewarded health information management and quality outcomes rather than just volume of services, you wouldn't see these same complaints," he says.
Kathryn Mackenzie is technology editor of HealthLeaders magazine. She can be reached at kmackenzie@healthleadersmedia.com.
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