For the most part, doctor fees are a mystery: If people see a doctor who is part of their insurance network, they are responsible only for deductibles and co-payments, and the price the health insurer pays is often a secret. But healthcare legislation under discussion does not directly address the out-of-network fee issue. And that is intentional, says Mark McClellan, MD, of the Brookings Institution. McClellan, a former head of Medicare, told the New York Times the goal of the House and Senate bills is to encourage people to stay in their networks. He added that the result should be networks that provide better care "so that people don’t have so much need to go outside of them."

At the last HIT Policy Committee Certification/Adoption Workgroup hearing in July, there was a very heated debate about whether the Certification Commission for Health Information Technology should be the sole certification authority for electronic health records, one of many certifying agencies, or banned from participating, in its current form, due to conflicts of interest.

The concern stems from the fact that CCHIT's leadership has strong ties to legacy software vendors and their trade group, the Healthcare Information and Management Systems Society.

Some IT executives never understood why there has been so much drama on the topic. CCHIT has been around for years, the Centers for Medicare & Medicaid Services endorsed it in 2006, and most of the major medical societies have endorsed it as well, says John Haughom, MD, senior vice president of clinical quality and patient safety at PeaceHealth, a seven-hospital system based in Bellevue, WA. "If they don't like CCHIT then work to revise it to make it better," he says.

The mood was quite different, however, at the Health IT Policy Committee meeting held this past Friday where the panel approved the Certification/Adoption Workgroup's recommendations, including that multiple organizations should be deemed certifying agencies for electronic heath record systems, as opposed to a single organization. The committee recommended that the National Institute of Standards and Technology, in coordination with the Office of the National Coordinator, should create an accreditation and monitoring process for the HHS certifying agencies. In the interim, however, CCHIT will lead the way in mapping out the certification criteria based on the HIT Policy Committee's recommendations outlined in the "meaningful use" matrix.

CCHIT, for its part, has already done a lot of work on that front. It submitted a proposal prior to the August 14 meeting to the policy committee, the certification/adoption workgroup, and National Health IT Coordinator David Blumenthal that mapped out a certification program that would launch in October. The proposal outlined how its certification program corresponded directly to the HIT Policy Committee's recommendations on meaningful use.

CCHIT's plan would also include options for certifying health IT products and services like e-prescribing and decision support, so that healthcare organizations and physicians who do not have a comprehensive EHR system can still prove meaningful use and qualify for stimulus funds.

The certification workgroup's recommendations also focused on:

1. Focus certification on meaningful use.
2. Leverage the certification process to improve progress on security, privacy, and interoperability.
3. Improve the objectivity and transparency of the certification process.
4. Expand certification to include a range of software sources, including open-source and home-grown systems.
5. Develop a short-term certification transition plan.

For more analysis of each focus area, check out this blog entry, "CCHIT has a Seat at Table–for Now" from Chilmark Research, a healthcare technology industry analyst firm.

While the debate surrounding CCHIT as the sole certifying agency may have ended, there are still many questions that remain. For example, how long will it take for other certifying bodies to be approved? Will vendors that have been certified by CCHIT for the 2008 criteria have to go through that process all over again? If not, who will qualify for gap certification? Stay tuned. There are new developments just about every day.

Korea is cracking down on patients that check into hospitals unnecessarily, often after car accidents, and cost insurers billons in false payouts annually. The new regulation comes as the economic downturn has recently been pushing up the number of patients who try to make free money from insurance payouts by faking injuries. Starting Aug. 28, hospitals will be responsible for keeping track of their patients' outdoor trips, and hospitals that fail to provide the information to insurers and government officials will face a fine of up to 3 million won ($2,430).

As the politicians and industry stakeholders continue the laborious effort to enact healthcare reform, opponents of the effort have criticized plans to nationalize the system. These opponents often point to Britain's National Health Service deficiencies as an example of why a government-run healthcare system should not be implemented.

But the British are firing back against these claims, defending the NHS and adding yet another voice to consider in the health reform effort.

Established in the 1940s, the National Health Service is publicly funded and provides healthcare to United Kingdom residents. Most services are free, but there are charges associated with some aspects of personal care. The NHS also has a formal constitution which sets out the legal rights and responsibilities of the NHS, its staff, and users of the service.

Critics of the system have pointed to long wait times and rationed care as just some of the detrimental aspects of the NHS. They say these problems would be common in the United States if the federal government takes hold of the system.

The defense of the NHS has come from a variety of sources, and not just those who have a stake in the system. UK residents have fired back in online sites like Twitter: on the thread "#welovethenhs," tens of thousands of citizens have shown their support for the NHS.

Prime Minster Gordon Brown has also voiced his support of the NHS, as has Conservative party leader David Cameron after a fellow conservative appeared on Fox News and criticized the NHS for its long waiting list for operations and a lack of patient choice. The remarks, made by parliamentary member Daniel Hannon, led Cameron to dismiss Hannan's view as "eccentric."

The UK Department of Health has also defended the NHS system, and say the NHS characteristics that are being criticized are actually what makes it most attractive. The Department of Health notes that the services are provided based on need instead of the patients ability to pay and note that patients can make choices about which hospitals they visit and physicians they see. The Department also says that life expectancy in the United States is lower than in the UK despite Britain paying much less per capita for healthcare.

While there is, without a doubt, problems with the National Health Service, it is interesting the amount of the broad public and private support the NHS is receiving in the United Kingdom.

And even with a health overhaul, it is highly unlikely that the United States system will ever be exactly like the National Health Service. Most hospitals in the U.S. will continue to be privately run, for example.

But can't everyone agree that the U.S. health system is not working as it currently is set up? Just last week, Remote Area Medical Foundation brought dozens of volunteer doctors, dentists, nurses and other healthcare professionals to a sports arena in Los Angeles to provide free medical services to the uninsured. The Foundation usually brings its services to severely impoverished areas of the world, and has staged health clinics in rural parts of the United States, Mexico, and South America. In its first foray into an urban area, the turnout was so large that hundreds had to be turned away.

Would it be so wrong to at least partially nationalize a health system so people don't have to be turned away? Someone should ask the hundreds of uninsured that went to the free clinic in the Los Angeles what they think about U.S. system—it is likely that they would agree that a system modeled after the NHS would not be all bad.