Only a "subset" of the initiatives proposed by major healthcare groups—including the American Medical Association, the American Hospital Association, and America's Health Insurance Plans—could result in meaningful savings for Congressional Budget Office health reform cost estimates, CBO Director Douglas Elmendorf wrote yesterday in a letter.
In the CBO letter, sent in response to a query by House Ways and Means Committee ranking member Dave Camp (R-MI), it was noted that the industry leaders' attention to the goals and "agreement that significant savings can be obtained are no doubt welcome."
However, most of the proposals are for steps that do not require the federal government involvement or "are not specified at a level of detail that would enable the CBO to estimate budgetary saving," Elmendorf wrote.
In a proposal to the White House earlier this month, the groups estimated that upward of $1.8 trillion in healthcare costs could be saved over a 10-year period. However, Elmendorf said some of the initiatives would promote good medical practice—such as hand washing to prevent infections—but would occur to a large degree without federal intervention.
Several proposals, while "not specific enough for CBO to estimate their budgetary impact," are similar to approaches the CBO analyzed earlier. They include:
Reducing Medicare payments to hospitals with high admission rates (which CBO said could save $5 billion to $10 billion over the next 10 years).
Capping the amount of noneconomic and punitive damages awarded in malpractice claims (which could result in net federal savings of $5 billion in the next decade).
Sen. Charles Grassley (R-IA), the ranking minority member of the Senate Finance Committee, commented that "the headlines generated by the White House event a month ago don't get us much closer to affording health care reform today."
The Health Information Technology Policy Committee stressed on Tuesday that the meaningful use definitions recommended by a study committee this week are merely a non-binding "first step" in a complex winnowing process. The final product could change a great deal when CMS issues a proposed rule change for a 60-day public comment period at the end of 2009.
However, David Blumenthal, MD, HHS' national coordinator for health information technology, did not dismiss the idea that components in Tuesday's first draft definition of meaningful use would remain in the final rules, which will be phased in from 2011 to 2015.
"It's going to be up to your readers to decide what they can read into the discussions that occurred today and what they can't," Blumenthal told HealthLeaders Media after Tuesday's three-hour meeting. "I suspect that as this discussion proceeds, certain themes will recur. I've certainly said publicly that we are very intent on using the meaningful use authority and the high-tech legislation to lay the ground work for improved health system performance."
"It's not going to be about technology to the maximum extent possible," Blumenthal says. "We are going to look for the effectiveness of systems in achieving healthcare change, rather than looking at the function and technical aspects of the system. The discussion today could only have reinforced that viewpoint, but that discussion is not binding, and the recommendations are not binding."
The recommendations discussed in the advisory committee meeting were drafted over the last month by the committee's meaningful use workgroup. "We had a lively discussion," Blumenthal says. "It was decided after considerable input on the topic of meaningful use that we would take the discussion back to work on it a little longer and bring back another set of recommendations to the health IT policy committee, which we will do in about a month."
The advisory committee meets again on July 16. "At that time, we will look at a revised set of recommendations on the definition of meaningful use," Blumenthal says. "If the committee can come to consensus on those definitions, it may be possible to produce recommendations within days or weeks thereafter. But I don't want to anticipate or predict exactly what the committee will decide to do."
President Barack Obama's recovery act provides about $19 billion in reimbursements through Medicare/Medicaid incentive payments to physicians and hospitals and other eligible providers that adopt "meaningful use" of EHR. The uncertainty of the definition has caused great angst and speculation because of scheduled reductions in Medicare reimbursements for providers, who don't meet the as-yet undefined "meaningful user" definition.
Jonathan Teich, MD, an assistant professor of medicine at Harvard Medical School, says Tuesday's first draft provides "a good sense of where things are going." "Some of the specifics may change, but if I were a CIO or a CMO, or a practicing quality leader, I think I would have a reasonable sense of what they are expecting," Teich says. "I know they are not expecting extreme outcome measures to happen in 2011. I do know also, though, that they expect me to be doing electronic ordering in that time. So, if I'm making purchases or setting up implementation timetables, this is a good start. We will see more changes over the next couple of months as things get refined and regulated, but I'd have a pretty good sense of what's going on now."
Teich says the meaningful use first draft also sends a clear message that the purpose of healthcare IT should be "to improve quality, safety, efficiency, access, and coordination of care."
"It's not how much technology you have. It's what it's doing for the benefit of healthcare in the country," he says. "There is clearly a progression from the technology I have to the performance I can do to the outcomes I can achieve. We are going to be moving from just technology, not quite for its own sake, but as something you implement, to technology as something that is a very big arrow in the quiver of improving outcomes. As we see refinements of the 2013 and 2015 objectives, I expect to see a lot more focus on moving into performance and outcomes."
Blumenthal says anxious providers will have ample opportunity to relay their concerns about the viability and cost of EHR. "There will be a long period of public input, which I'm sure will include a lot of input from the profession," he says. "We have a number of providers on our health IT policy committee and others who speak with a provider perspective."
"I don't want to put words in the mouths of the nation's providers, but I anticipate we will be hearing from them about concerns in a number of areas: how fast they can adopt electronic health records; whether they can meet our criteria for certified use, and how the federal government will certify those records," Blumenthal says. "These are all areas that we are carefully considering and we look forward to getting providers input in all these areas."
CMS and the Office of the National Coordinator for Health Information Technology will take the recommendations of the advisory committee and develop a proposed rule that provides greater details on the incentive program and a firmer definition of meaningful use. The proposed rule is expected to be issued late in 2009, and will be followed by a 60-day public comment period.
President Obama's plan to expand health coverage is likely to dig the nation deeper into debt unless policymakers adopt controls on spending, such as sharp reductions in payments to doctors, hospitals, and other providers, congressional budget analysts said. The pronouncement from the Congressional Budget Office is likely to complicate the task of enacting comprehensive changes this year. Democratic lawmakers will lose support unless they produce a package that has the potential to lower the nation's debt. But hospitals and drugmakers already are balking at proposals that would cut their federal payments.
J. James Rohack, MD, dived into the scrum over healthcare reform on Tuesday when he was inaugurated as the 164th president of the American Medical Association.
Rohack, a cardiologist from Bryan, TX, will lead the nation's largest and most powerful physicians' organization at a time of profound change, as the nation undergoes the most concerted push to adopt far-ranging changes to the healthcare delivery system since the Medicare program was adopted in the 1960s.
He replaces Nancy N. Nielsen, MD, who made headlines in her final weeks as AMA president when she defiantly told the New York Times that "we absolutely oppose government control of healthcare decisions or mandatory physician participation in any insurance plan." Nielsen softened her remarks this week, after Obama addressed the group on Monday, and she said "the AMA will figure out a way that can best help the president reach the goals we share, which is affordable health insurance for all Americans."
In his first address before the 250,000-member organization as its president, Rohack told physicians attending the 158th AMA Annual Meeting that a "uniquely American solution" to healthcare reform must deliver "evolutionary change." He renewed the AMA's commitment to healthcare reform that improves access to high-quality, affordable care for all patients.
"I can promise that our AMA is committed to offering guidance, our expertise, the benefits of our relationship with patients, and the powerful voice of our profession, to help the powers that be make the right decisions," Rohack told the gathering. "This is an effort that will define our organization, define our nation and define each and every one of us."
Rohack was first elected to the AMA Board of Trustees in 2001, and he served a term as board chair in 2004-2005. He has chaired the AMA Council on Medical Education and represented the AMA on the Liaison Committee on Medical Education, the Accreditation Council on Continuing Medical Education, The Joint Commission, and the National Advisory Council to the Agency for Healthcare Research and Quality. He continues to serve on the Hospital Quality Alliance.
Rohack held leadership positions in Texas, and was first elected to represent Texas physicians in the AMA House of Delegates more than 20 years ago. He is a former president and board member of the Texas Medical Association. Rohack also served as president of the American Heart Association's Texas affiliate.
Rohack is a professor in both the Department of Medicine and the Department of Medical Humanities in Medicine at the Texas A&M Health Science Center College of Medicine, director of the Center for Healthcare Policy at Scott & White, and medical director for system improvement for Scott & White Health Plan in Temple, TX, where he continues his clinical practice.
Rohack completed his undergraduate education with highest honors at the University of Texas at El Paso and earned his medical degree with honors from the University of Texas Medical Branch at Galveston in 1980.
Executives of three of the nation's largest health insurers told federal lawmakers in Washington that they would continue canceling medical coverage for some sick policyholders, despite withering criticism from Republican and Democratic members of Congress who decried the practice as unfair and abusive. An investigation by the House Subcommittee on Oversight and Investigations showed that health insurers WellPoint Inc., UnitedHealth Group and Assurant Inc. canceled the coverage of more than 20,000 people, allowing the companies to avoid paying more than $300 million in medical claims over a five-year period.
Newton-Wellesley Hospital has withdrawn its plan to build an outpatient surgical facility in Framingham, MA, following objections and a legal challenge by competitor MetroWest Medical Center. The nonprofit Newton-Wellesley Hospital, owned by Partners HealthCare, proposed the 24,000-square-foot facility in Framingham to handle an overflow of surgical outpatients from its main campus in Newton.
As the recession forces more hospitals and doctors to pare costs, the cutbacks are especially affecting children covered by Medicaid, who are being turned away from receiving care. While children have always made up about half of Medicaid's rolls, their numbers have swelled in recent years to the point that at least 22 million, or one in four, U.S. kids now get their health coverage through Medicaid or a state Children's Health Insurance Program.
New York legislation called the Patient Protection Bill was signed into law by Gov. Eliot Spitzer in July 2007 and is intended to ensure high safety standards in offices when surgery and other invasive procedures are conducted with more than minimal sedation. It is the first time that New York State will regulate office-based surgeries. Doctors doing surgery will be required to have their offices accredited by one of three existing agencies by July 14, or face penalties for professional misconduct if they continue to perform operations.
A day after President Barack Obama sought doctor support for his health reform plan, the American Medical Association talked of meeting him at the bargaining table in support of some form of publicly funded health insurance option. Details of the proposed option are expected to be negotiated in the weeks and months ahead, but a key sticking point was whether the politically powerful AMA would agree to support a government-led insurance option for the more than 46 million uninsured Americans.
A former Caritas Christi Health Care System executive sued the Massachusetts-based hospital chain for allegedly retaliating against him after he privately voiced support for a colleague's discrimination claim, telling her she had been "sold out by white males." Michael Metzler, former president of St. Anne's Hospital in Fall River, MA, alleged in a federal lawsuit Caritas Christi reneged on a promise to pay him $250,000 for three months of consulting work after he retired two years ago. Metzler said Caritas Christi decided to punish him after discovering he had sent a supportive e-mail to Susan Labus after she was passed over for Metzler's job and complained to hospital officials she was the victim of gender discrimination.
