Next Things First


Lost in D.C. with The Dartmouth Atlas (reprint) by Rob Coppedge
June 27, 2010, 7:36 pm
Filed under: health policy, value-based purchasing

Amazing what does not change in a year’s time… this post, originally posted to the Health Value Blog a year ago, is still as relevant as it was then. Perhaps even more important now – since the Dartmouth Atlas (and its use by Atul Gawande in his now famous New Yorker piece) influenced much of the health reform debate.

The HVBlog pulled this post – and I am very pleased that the authors have given us permission to reprint it here…

Lost in D.C. with The Dartmouth Atlas

by Hal Andrews & John Morrow

We know some of the people involved in the Dartmouth Atlas Project, and we think their analysis is important. Even so, using 2005 Medicare data to inform comprehensive payment reform is inadequate.

As such, we are surprised and dismayed at how policymakers are using the findings as the map for healthcare reform in Washington, D.C. We are also frankly appalled at how The New Yorker article by Dr. Atul Gawande has seemingly become the guidepost of reform for policymakers. The reason is that the conclusions that The White House and much of Congress have drawn from The New Yorker article are, at best, suspect and, at worst, completely wrong. Reengineering 20% of the economy is a large task, in our view, and getting the facts straight is important.

So, what have we done? Instead of using an “Atlas” to analyze McAllen and El Paso, we suggest using a “GPS” to triangulate the position that hospitals played in overall excess cost and utilization. Doing so provides some critical facts that The New Yorker failed to report.

At first blush, McAllen and El Paso are quite similar:

  • 2008 populations are within 1% (752,020 for McAllen vs. 759,868 for El Paso).
  • Median age of the population is similar, at 28.2 years for McAllen compared to 30.6 years for El Paso.
  • Per capita income for each market is depressingly low, with $12,276 for McAllen and $16,838 for El Paso (making El Paso 37% wealthier, as suggested by the physicians in McAllen).
  • Medicare hospital utilization rates are similar, with 28% Medicare utilization in McAllen and 30% Medicare utilization in El Paso.
  • Total hospital utilization (i.e., all-payer data) when compared to the population were similar in calendar year 2007 (the most current year that all payer data is available), with 12% hospital utilization in McAllen versus 10% hospital utilization in El Paso.
  • Each market has 2% workers’ compensation hospital utilization.
  • Per capita hospital utilization is similar, with a rate of .48 patient days per capita in El Paso compared to .53 patient days per capita for McAllen.
  • McAllen cost per case is 5.4% lower than El Paso, and McAllen’s average length of stay is 9.6% lower than El Paso.

Based on these similarities, McAllen is in many ways a more desirable option for hospital care.

So, what about the real differences between McAllen and El Paso?

Overall, and not just for the Medicare and Medicaid population data (which were central to the Atlas and The New Yorker perspective), McAllen’s average cost per case is $315.00 less than in El Paso, representing in total $23.6 million in incremental costs that could be saved if all of the El Paso cases had been treated in McAllen hospitals. For policymakers who are concerned about the price paid by the uninsured, the average charge per case is $7,841 more in El Paso than in McAllen.

Importantly, the “excessive” costs attributed to McAllen do not occur in McAllen, or even in Hidalgo County. A full 6% of McAllen residents left McAllen for care to other markets such as Brownsville, Houston, San Antonio, Corpus Christi and Dallas! A total of $283 million in charges migrated away from McAllen, yet those costs are attributed to the population and demographics of the beneficiaries living there. As a result, the Dartmouth Atlas analysis overestimates the costs attributed to McAllen. As a comparison, $63 million of charges out-migrated from El Paso to other Texas hospitals during the same period (the all-payer analysis does not reveal out-migration to any other states; El Paso is closer to Phoenix than Dallas).

What about the important things, like quality? The March 2009 release of the Hospital Value Index™ reports McAllen’s average index score at 42.76 with El Paso’s being 43.83, just over one basis point difference. This indicates that the markets are nominally different on quality, core process measures, mortality, patient safety and patient satisfaction and experience. Shorter lengths of stay, lower costs, and lower mark-ups for charges on patient bills make for a more desirable profile of McAllen hospitals than El Paso.

In summary, the most current all-payer data (2007) simply does not support The New Yorker piece, which was partially based on 2005 Medicare data from The Dartmouth Atlas. For both McAllen and El Paso, the cost per beneficiary would decrease if the beneficiaries did not leave the market.

These markets have a great deal in common, but critical differences not discussed in The New Yorker. We are reminded how important it is to “follow the money”, yet without the anecdotes about what is going on in McAllen, the empirical data report that the hospitals in McAllen aren’t the problem.

We think that there are several important questions that arise:

  • Could an entire industry be led astray by the miscalculations of Medicare spending delivered by a half dozen hospitals in McAllen and El Paso?
  • Should policymakers draft legislation to reform the provision and coverage of healthcare based solely on (old) Medicare data?
  • Is the nation going to allow a handful of well-meaning, but uninformed, policy-makers to reform healthcare based on the view of an article in The New Yorker?

Heaven help us if we do…

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Reform: Finally, Some Discussion of the Real Issues by Rob Coppedge

In light of all the distraction recently generated by discussions of health care IT (and even, cue the smoke machines, Health 2.0), I was very pleased to find Senator Tom Coburn, MD, and Regina Herzlinger’s piece in the Huffington Post.

In a week that for many of us has been dominated by reading the “wouldn’t-it-be-cool-ifs” of messenger bag-carrying technology evangelists, it was refreshing to see a call for a much needed national debate around the *real issues* facing the health care system.

With little fanfare, Congressional leaders may be near to agreeing on the most sweeping expansion of government in a generation – the de-facto takeover of the health insurance market by the government. Congressional Democrats are already icing the champagne. When the President’s “Medicare for all” plan is coupled with the budget, which contains a “down payment” of $634 billion over the next decade for health care, government-run health care may be inevitable.

All sides in this debate acknowledge that the U.S. has long needed easier access to health insurance. This need has gained urgency for the many Americans who are fearful of losing their employer-sponsored insurance in the midst of a recession. Unfortunately, the President’s plan will not only endanger the U.S. economy, but millions of patients as well.

They make clear that the issue here is cost containment. Or, perhaps better, that solving the “access” issue without controlling costs may be politically expedient but is a recipe for disaster.

The fundamental problem is that the President and congressional leaders lack realistic plans to control the health care costs that are already crippling U.S. global competitiveness. As a percentage of GDP, our businesses spend roughly 70 percent more on health care than competitors in other developed nations, yet we hardly receive 70 percent more in real value.

We talk a lot about cost containment – and in the world of health care venture capital, some of the most exciting investment opportunities address just this set of issues. But translating these decidedly market-focused ideas into terms that are politically palatable is difficult. Denying reimbursement for treatments, no matter their relative value or efficacy, has interest groups rushing to mount the barricades. However, as Coburn and Herzlinger point out, there is a risk of even greater hazard if we don’t engage the cost containment challenge now:

In the end, the Democrats’ health care reform will require drastic rationing… Consider Canadian patients, who may wait a year or longer to get radiation therapy. Or ask one of the nearly 1.8 million Britons who are waiting to get into a hospital or have an outpatient procedure. Or talk to the German breast cancer patients who are 52 percent more likely to die from the disease than Americans.

Concerns about rationing and patient outcomes are not demagoguery. How else can a government control costs in the real world? Many experts, including the Congressional Budget Office, dismiss as wishful thinking the Democrats’ claims of achieving efficiencies through bureaucrats’ dazzling implementation of information technology and other technocratic tools.

And this is where the real world collides with the health care technology bandwagon. It goes without saying that health care lags behind in the implementation of back office and administrative information technology. And certainly this is due in some part to all the factors that are debated regularly in the blogosphere. However, it is also due to the basic fact that there has been little ROI for physicians implementing these technologies.

I worry that we are just further confusing the issue. As my colleague Alan Buffington points out:

Isn’t it interesting that no matter how many times they are corrected, politicians and media folk refuse to distinguish between health care and health insurance.  Failing to make this distinction is what causes the problems discussed in the article.

If you watch the blogs, Twitter or CNN, you will have proof that the problem Alan points out is deep and widespread. The problem with health care is that it is “hard” – complex, path dependent, interlocking, huge, with substantial ethical and moral considerations. For most people (especially politicians),  this is way too much.

Posted by RobC

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Remembering Rick Carlson – In His Own Words by Rob Coppedge
April 23, 2009, 11:30 pm
Filed under: health policy | Tags: ,

Today in Seattle, the memory of health care thought leader and industry veteran Rick Carlson was celebrated by a room full of friends, family and colleagues. Around the room, Rick’s family had posted quotes from his articles and books – which served as both a testament to Rick’s talent as a thinker and writer and as a virtual history of health care reform efforts.

I appreciate Rick’s son Josh allowing us to share these excerpts. They are important now as we remember Rick – and perhaps even more so as we prepare for a yet another vigorous  health care debate.

“Well over half of those who seek physicians’ services do not have medical disorders. Rather they are afflicted by disorders of the spirit bred by the suffering and anguish that accompany life.….. [M]edicine has fostered a profoundly dependent public which searches for cures that do not exist.” The End of Medicine. Pg 26-27.

”Should all (technological) improvements be considered health care and thus covered by existing (insurance) plans – full speed ahead and damn the premiums?” The Terrible Gift. Pg 235. 2003.

“If someday we want to think seriously about subjugating medicine to the needs of society, there are basically three roads we can take. First, we can decide not to… Alternatively, we can ask government to level the playing field a la Scandinavia. … There is a third possible road: we can — and most likely we will — jury-rig a hybrid combining some of the pros and cons of each of the first two models.” The Terrible Gift. Pgs 231-233. 2003.

“The emergence of molecular control technologies raises a truly Darwinian question of survival for much of the human race. Perhaps Americans can plan safe and worthy use of biotech medicine only after we confront our true place in the world and learn to see ourselves as others see us. Until then, trusting our secret agencies with the keys to life could be the worst policy decision since Montezuma showed Cortez the Gold Room.” The Terrible Gift. Pg 223. 2003.

“Genomics will force us to decide what we are willing to pay for health care, in costs both financial and social. Because of its size and power, our health care system might be compared to a mighty river. As therapeutic medicine expands and an entirely new currents of upgrade medicine improve human endowments and performance, that stream could overflow its banks and inundate all other aspects of life.” The Terrible Gift. Pg xii. 2003.

“To a degree, the rise of personal genomics markets, generally, is an outgrowth of rising consumer activism in health care under the rubric of ‘consumer-directed health care.’ The policy objective is to increase the consumer’s investment of time, commitment to health living, and most of all money, into the health care system…. The long term expectation (hope?) is that an educated, motivated consumer with ‘skin-in-the-game’ will be more parsimonious in the use of scarce health care resources.” Personal Genomics: public policy at the frontier of consumer markets in health care. Pg 1. 2009.

“The personal genomics market leaders deny that they are just selling ‘curiosity’ to the affluent and worried well, arguing that individuals fortified with personalized data will be motivated to address and minimize controllable risk factors and hence prevent or at least slow the onset or progression of chronic disease. This is a provocative and promising premise, and may be right, but to date we have very little evidence to support it, acknowledging at the same time that we haven’t had enough experience with highly personalized risk information to know the likely answer.” Personal Genomics: public policy at the frontier of consumer markets in health care. Pg 2. 2009.

“..genetic discrimination can be practiced by communities, and social systems, not just by employers and insurance companies, though its forms are different….And, finally, it is now being appreciated that much of our accumulating genetic information could lead us down one of the slipperiest of slopes if it becomes the fodder for engineering human perfection.” Personal Genomics: public policy at the frontier of consumer markets in health care. Pg 5. 2009.

“In my view, the choice to develop a system to delivery medical care through nearly exclusive allocation of resources for that purpose, was made for political, social and economic reasons rather than for therapeutic ones.” Western Journal of Medicine. Pg 466. 1979.

“Holistic thinking, as an epistemological notion, requires that human beings be perceived as whole persons made up of physiological, emotional, intellectual and spiritual dimensions that dynamically interact, and that any approach to improving the health of human beings, either individually or in groups, requires placing them in a larger and richer context than does traditional medicine.” Western Journal of Medicine. Pg 468. 1979.

“In health care, genomics technologies are disruptive yet potentially cost-effective because they enable primary prevention, the antidote to runaway costs and declining productivity. The challenges to integration are great, however, and many bioethical and social-policy implications are alarming. …we must debate genomics vigorously if we are to act wisely. Public policy must lead.” Journal of Health Politics, Policy and Law. Pg 39. 2008.

“ [genomics] is aikido, not Special Forces. Genomics taps the body’s wisdom by immersing itself in the ebb and flow of the body’s information system – the genome – rather than by looking only to extirpate the results of molecules gone bad by providing a patch and then leaving us ignorant of the proximate cause…. We are not born healthy and made sick; rather we are born predisposed to certain conditions, characteristics, strengths, and limitations.” Journal of Health Politics, Policy and Law. Pg 42. 2008.

“As genomics metastasizes, every business model for every health care sector will be affected, some profoundly.” Journal of Health Politics, Policy and Law. Pg 43. 2008.

“[HMOs’] initial cost-cutting success – achieved with an axe, not a scalpel – led the way to the hedgerows of the vilified managed care cost-control systems that followed.” Journal of Health Politics, Policy and Law. Pg 46. 2008.

“Lots of money will always be made in health care – we just need to give those who make markets reasons to make the ones that would improve our public’s health.” Journal of Health Politics, Policy and Law. Pg 48. 2008.

“In the 1950’s, when the Salk vaccine displaced the crude technology of the Iron Lung, science writers and the popular press loudly proclaimed the arrival of a golden age of modern medicine, a medicine that would systematically eradicate the lengthy and gory list of human maladies. That age proved to be more tin than gold. ..This must necessarily chasten any prediction about the future of medicine.” Public Health Genomics. Pg 180. 2009.

“Our private health insurance model is a hybrid of economic ruthlessness and utilitarian social policy…. through which we are made to take care of each other though abstractly, because the benefits we don’t need go to meet the needs of others we don’t know.” Public Health Genomics. Pg 182. 2009.

“There is a real peril that lowbrow theories wrapped in tendentious and oily slogans will get the public’s ear and gain even footing with scientific proof as worthy of belief.” Health Affairs. Pg W-5-467. 2005.

“Real reform is not on the agenda. There is no money for real reform because we spend it all on medicine.” Healthcare Forum Journal. Pg 18. 1993.

“Policy initiatives are being tossed around like obscenities at a hockey game…” Healthcare Forum Journal. Pg 18. 1993.

“Perversely, since job creation is the central goal of this new administration, reforming the medical care system by cutting costs may just be the worst thing to do…. No tooling up is required. Just let the tides loose. Medical care can and will encroach like the worst weeds in your prized front lawn.” Healthcare Forum Journal. Pg 21. 1993.

“Here are my suggestions for initiating real reform:

  1. Explode the physicians’ worm’s-eye view

  2. Dismantle the replicating engine

  3. Discipline the spoiled child

  4. Turn the reward system upside down

  5. Honor the consumer

  6. Admit that we can’t afford it anymore

  7. Get rid of the insurance industry

  8. Force medicine to be a science

  9. Advocate health aging”

Healthcare Forum Journal. Pgs. 18-26. 1993.

Posted by RobC

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Remembering Rick Carlson by Rob Coppedge
February 19, 2009, 9:27 am
Filed under: health policy, seattle market | Tags: , , ,
Rick J. Carlson

Rick J. Carlson

We were shocked to receive the news that our good friend and colleague Rick Carlson passed away last week. He will certainly be missed – as most good friends are – but the impact of losing Rick will run deeper. He was a living reservoir of experiential knowledge of the health care system’s experiment with managed care. He had seen the good and the bad – and was not afraid to point out the ugly, even in his own contributions to the system.

I would often introduce Rick as an architect of the HMO Act and the guy who “named” health maintenance organizations. “I am still living that down,” he’d retort.

Despite his ability to effortlessly list (and list and list) the failings of the current system, he was a close advisor to many of the biggest players in the business. His Rolodex was deep and full of friends – he often counseled me on the importance of actively cultivating and investing in one’s network. He was always early. He always followed up. He said it was because he was Swedish, but I haven’t met any other Swedes like Rick.

He was extremely excited about the changes on the horizon for the health care system – and spoke often of what he called the “Next Health Care Delivery System” where innovation focused on service delivery and treatments were assessed for comparative effectiveness. In the Next System, we would get back to managing the care of patients and use technologies to empower patients with the information they need to take better care of themselves. It was for him the logical extension of what he and his colleagues had attempted to build in the 1970s.

I valued Rick’s professional counsel and was honored when he joined Faultline Venture’s advisory board. He was excited to jump into the activities of the firm – helping communicate the exciting opportunities in the health care market to potential investors and advise early stage companies how to avoid the potholes he had seen. But more than that, he was a wonderful friend. He was one of the first calls I made when we decided to move to Seattle (“Great idea… its the right time”) – and has provided counsel on a range of subjects that he knew well (little local restaurants, great cups of coffee, amazing hiking trails, etc). Rick took an interest in us and we have been so much the better for it.

Many of us will feel the void his loss has left, and not just those who knew him well. It is the loss to the young health care entrepreneur that won’t have the value of Rick’s counsel that worries me most. I’d love to tell him that he was the one that got us into this mess and he has to stick around to help us get out. However, as I survey all the lives he has touched and careers he has influenced and friends who will carry his memory, I believe maybe he’s done just that. Now it is up to us to build the Next Health Care System.

RICK J. CARLSON

Rick J. Carlson, a renowned health consultant and one of the prime architects of the “Health Maintenance Organization Program” (HMO) died of a heart attack on Friday February 13th. Rick, who lived with his family in Aspen for twenty years had an impressive, illustrious and full career.  Born in 1940 in Minneapolis, Minnesota

Rick went to St. Olaf College and then went on to receive his JD at the University of Minnesota.

In 1968 Rick joined the Institute of Interdisciplinary Studies (currently Interstudy of Minneapolis, Minnesota) as a research attorney where he drafted the legislation which initiated the health maintenance organization movement across the country.  Following this work he was invited to be a Visiting Fellow at the “Center for the Study of Democratic Institutions” in Santa Barbara, California and during his 18 month tenure there he published his first book, THE END OF MEDICINE, which was a seminal book in the health field.  His work at the Center on issues pertaining to law and justice led to his writing his second book, THE DILEMMAS OF PUNISHMENT in 1976.

While living in California Rick served as the chairman of the California governor’s Council on Wellness and Physical Fitness and became the first director of the California Trend Report Project.  Over the years Rick worked as a consultant to major institutions in the healthcare industry, such as the Blue Cross/Blue Shield Associations of America, the America Hospital Association, the Health and Human Services Administration, the MacArthur Foundation and others.  In 1978 Rick authored THE FRONTIERS OF SCIENCE AND MEDICINE and in 1985 co-authored with Clement Bezold THE FUTURE OF WORK AND HEALTH.  From 1987 to 1990 he served as President and Chief Executive Officer of NewHealth Centers/PPP Inc which worked in the development and establishment of Primary Prevention Program Centers and state-of-the-art risk assessment systems.  In addition Rick was “Of Counsel” to Epstein, Becker & Green, P.C., a law firm with offices across the U.S..  Rick also served as the President and CEO of HealthMagic, a healthcare technology company headquartered in Denver and was Vice Chairman of Age Wave Health Services located in the San Francisco Bay area.

In 1987 Rick co-authored ISSUES AND TRENDS IN HEALTH with Brooke Newman and in 2002 co-authored with Gary Stimeling THE TERRIBLE GIFT, an assessment of the promises and perils of biotechnology.

In 2001 Rick became Clinical Professor Policy Programs Department of Health Services and Affiliate Professor Department of Pharmacy, School of Public Health at the University of Washington, Seattle.

Rick’s enormous body of work was an impressive accomplishment but his absolute greatest achievement in life was as an extraordinary loving, devoted, wonderful father to his four children Blue (Gyorgy), Joey, Josh and Rebecca, and his step-children Nikos and Samantha Hecht.
He will be dearly missed at the Aspen Ice Garden where he spent many an hour proudly watching Blue and Joey playing hockey.  And, indeed he will be missed by the hundreds of people he deeply influenced and touched personally.

The date for a memorial service will be announced within a few weeks.



Wielding Technology’s Wonders by charlottegee
January 22, 2009, 8:57 am
Filed under: health it, health policy | Tags: ,

Google “Obama and health care” and be prepared to wade through link after link, opinion after opinion. During the excitement surrounding Tuesday’s activities, many in the health care world listened intently to the President’s speech, all ears for health care mentions. The Wall Street Journal’s Health Blog highlights the two:

———-

We, focused as ever, listened for any tidbits about health care and heard two. First, there was an acknowledgment of the expense of health care in a long list of woes the nation now faces.

That we are in the midst of crisis is now well understood. Our nation is at war, against a far-reaching network of violence and hatred. Our economy is badly weakened, a consequence of greed and irresponsibility on the part of some, but also our collective failure to make hard choices and prepare the nation for a new age. Homes have been lost; jobs shed; businesses shuttered. Our health care is too costly; our schools fail too many; and each day brings further evidence that the ways we use energy strengthen our adversaries and threaten our planet.

Later, in keeping with Obama’s seemingly ceaseless message of hope, health came up again as the president talked about how the U.S. can “lay a new foundation for growth.”

For everywhere we look, there is work to be done. The state of the economy calls for action, bold and swift, and we will act – not only to create new jobs, but to lay a new foundation for growth. We will build the roads and bridges, the electric grids and digital lines that feed our commerce and bind us together. We will restore science to its rightful place, and wield technology’s wonders to raise health care’s quality and lower its cost. We will harness the sun and the winds and the soil to fuel our cars and run our factories. And we will transform our schools and colleges and universities to meet the demands of a new age. All this we can do. And all this we will do.

—–

People are appropriately a-buzz with the prospect of money being poured into renewed focus on health information technology. Many are for it, saying the time is now and let’s get moving–yesterday!; many are against it, arguing that there are plenty of other (better) ways to help the system; many say that it sounds good on paper and over the speakers, but you’d better have a pretty smart checklist in place before making any moves.

After the speech, Virginia Postrel and Shannon Brownlee had an online conversation, posted on The Atlantic, about the intricate nature of the health care system–touching on issues ranging from interoperability to EMRs to innovation in medicine. Shannon notes:

What’s interesting is the fact that the federal gov’t has to get involved in stimulating EMRs in the first place. I can’t think of another major industry that has not decided to invest in computerized records. Why not health care? Because you don’t get rewarded for doing a better job of caring for patients, or doing it more economically, two things that EMRs could help providers do.

Wherever you fall on health care reform, 2009 is sure to be an interesting show. Set the DVR.

Posted by CharlotteGee



The Big Push for Healthcare IT … Economic + Political Perspectives (From Howard Luks) by charlottegee
December 15, 2008, 10:57 am
Filed under: economy, health it, health policy | Tags: , ,

During a speech last week in DC in front of the Department of Health and Human Services Health Policy Forum (with nearly 50 of America’s thought leaders on disruptive healthcare), Ben Sasser, the Assistant Secretary of Health, commented that the projections for Medicare Part A funding were wrong. The Department figured out last week that Part A funding will be bankrupt prior to the end of Obama’s second term!! And solvency of Medicare will not be the only healthcare (HC) issue this administration will need to tackle.

President-elect Obama, Senator Baucus and others are crafting numerous initiatives they plan to bring forward early during the new administration’s first term. Most of these initiatives are geared toward *reforming* the healthcare system. There are innumerable issues that need to be addressed under the auspices of HC reform. Access, quality, efficiency, diminishing medical errors, minimizing duplication, waste and affordability are *simply* a few of the issues the administration will need to contend with.

It appears the incoming Obama HC team believes, right or wrong, that a big push into HC IT infrastructure will pose as the spark toward adoption of more widespread reform. There are both economic and political reasons why it makes sense to tack the IT spend onto the current stimulus package under consideration.

From an economic perspective, a big push into HC IT will result in jobs being added to the only sector of the economy that has demonstrated job growth over the last two quarters. Heading into 2009, job growth is going to slow in the HC sector as federal and state Medicaid funding is severely cut during the next round of budget cuts. (Consider: In New York State, Governor Patterson’s staff already has informed hospitals to plan for their worst nightmare.)

Combined with the tightening of the credits markets, hospitals are going to be hard pressed to offer services to the poor, uninsured and under-insured. “No margin, no service” will become the rule of the hospital landscape in 2009. Both the credit markets and financial issues will most certainly impact the ability of hospitals to pursue large capital intensive IT initiatives.

The AMA news recently reported that “Despite changes to federal rules that allow hospitals to donate health IT to physicians, studies show neither hospitals nor physicians are jumping at the opportunity.” No doubt, the cuts in state funding, the increase in the uninsured, and thus the increased financial stress on hospitals that offer services to the uninsured, will make it impossible for hospitals to spend money on IT without government assistance.

Therefore, *if* the incoming administration *believes* that a HC IT initiative is necessary as a stimulus for job creation and broader HC reform, the timing for tacking on a HC IT initiative as part of the current stimulus package is perfect.

From a political perspective, tacking on a HC IT spend to the current economic stimulus package will virtually assure its passage. The Democrats are working very hard to get a *comprehensive* stimulus package ready for President-elect Obama’s signature within a few weeks of entering office. All indications point to the fact that the monetary figure will be enormous — but many economists believe that deficit (Depressionary) spending and contemporary New Deal programs are *necessary* if we are to avoid a significant deepening of the current recession. That theory will give proponents of a HC IT initiative the ammunition necessary to obtain the necessary support for a 5-year, $50-billion IT package.

Perhaps most important: After the passage of an enormous stimulus package, it will be difficult for the new administration to obtain support of an exceptionally expensive comprehensive healthcare reform package — strictly based upon the cost of such an effort. By taking the $50 billion IT spend (and SCHIP spending) out of the HC Reform package, the overall cost of healthcare reform will *appear* lower … and perhaps more palatable to fiscally conservative members of Congress.

Bottom line? Healthcare IT is estimated to be at least a $50 billion industry in the United States. Anybody who chooses not to participate could be giving up a potentially large amount of revenue.

Submitted by Howard J Luks, MD



Obama Watch: Update on Daschle’s Team (from David Kreiss) by Rob Coppedge
December 11, 2008, 11:46 am
Filed under: health policy | Tags: , ,

Here’s the first of Senator Daschle’s crew to be named – From today’s NYT:

“Jeanne Lambrew, who helped Daschle write a book about health care reform, will serve as deputy director of the new White House office. She also worked on health policy at the White House during the Clinton administration and currently serves as a senior fellow at the Center for American Progress, a liberal think tank… Leaders of health advocacy groups have described Lambrew as one of Daschle’s most trusted advisers on health issues. She will oversee planning efforts.”

(For the full text of Obama’s nomination click here.)

Posted by David Kreiss – among many  things, former Special Assistant to the Administrator of CMS