healthcarereimagined

Toplines

• Current transparency efforts in health care produce information that’s too complex and hard for consumers to access

• Smartphones, apps, and wearable devices could facilitate a new kind of data transparency that benefits our health
  

Toplines

Survey: Democratic and Republican state legislators agree on one health reform goal: reducing health care costs

Other priorities for Republicans include limiting the size of government; for Democrats, improving health outcomes

Synopsis

Health reform has become a politically divisive issue in the United States. But survey responses from Democratic and Republican state legislators show that both parties agree on one thing: the importance of reducing health care costs. While the parties have other competing priorities — like increasing access to health care and reducing the role of government — tackling costs could provide a basis for future bipartisan health reform.
The Issue

This survey demonstrates that common ground between Republicans and Democrats can be found on the sufficiently challenging task of tackling health care costs.
The passage of the Affordable Care Act and the many attempts to repeal and replace the law reflect the highly polarized nature of health care reform in the United States. Many observers have argued that only health reform carried out in a bipartisan manner is sustainable over the long run. But making such reform possible requires both Democratic and Republican policymakers to converge around specific, articulated health policy goals. A research term led by Christina Pagel, a 2016–2017 Commonwealth Fund Harkness Fellow in Health Care Policy and Practice, surveyed state legislators about their health policy goals to gain insight into the opportunities and challenges for future bipartisan reform.

Key Findings

Republican and Democratic state legislators differ in their priorities for health care but agree on the importance of reducing costs for individuals and families, as well as for payers, like government and employers. Republicans prioritize reducing costs and limiting the size of government. Democrats place improving health and equity outcomes and reducing costs at the top of their agenda.

Republicans are split on the relative importance of improving health versus limiting government involvement. About 30 percent of Republicans surveyed gave high priority to improving overall health and lower priority to reducing government involvement in health care; 40 percent said the opposite.

Republicans and Democrats disagree about the level of involvement the government should have in health care. Overall, Republicans ranked reducing the role of government as their second-most important priority, while Democrats ranked it lowest out of 13 possible goals.

The Big Picture

Based on the survey’s findings, Democratic-only health reform would prioritize expanding access for individuals and government-driven efforts to improve health outcomes. Republican-only reform, on the other hand, would prioritize limiting the role of government and decreasing government spending. Both sides agree on the importance of reducing costs, making it the most obvious area for bipartisan collaboration — provided that cost-control policies do not adversely affect the parties’ other goals. The authors suggest that advocates for health policies should emphasize their impact differently. For Democratic lawmakers, they should highlight the policy’s impact on reducing health disparities. For Republican lawmakers, they should focus on the potential for decreased government spending.

About the Study

The researchers surveyed a group of state legislators for their views on a list of 13 health policy goals developed with input from a bipartisan group of policymakers. The surveyed lawmakers all serve on health or budget committees in state legislative bodies. The research team received responses from 377 legislators: 192 Democrats, 182 Republicans, and three others.

Publication Details

Post link: http://www.commonwealthfund.org/publications/in-the-literature/2017/aug/bipartisan-health-reform-state

As Congress continues to negotiate a repeal and replacement of the Affordable Care Act (ACA), some observers have suggested that if Republicans are unable to pass a replacement plan, it will create momentum for Democrats to push the country towards a single-payer health care system. This section of the latest Kaiser Health Tracking poll finds that while there has been a modest increase in the public’s level of support for single-payer in recent years, a substantial share of the public remains opposed to such a plan, and opinions are quite malleable when presented with the types of arguments that would be likely to arise during a national debate.

Trending Support for Single-Payer

The June Kaiser Health Tracking poll finds that a slim majority of the public (53 percent) now favors a single-payer health plan in which all Americans would get their insurance from a single government plan, while just over four in ten (43 percent) are opposed. This is somewhat higher than the level of support found in a variety of Kaiser polls with slight variations in question wording dating back to 1998. From 1998 through 2004,  roughly four in ten supported a national health plan, while about half were opposed. In polling from 2008-2009, the period leading up to passage of the ACA, the public was more evenly divided, with about half in favor of a single-payer plan and half opposed.

Figure 1: Modest Increase in Support for Single Payer Health Care in 2017

Independents May Be Driving Slight Shift in Overall Attitudes
Not surprisingly, there are partisan divisions in how the public feels about single-payer health care, with a majority of Democrats (64 percent) and just over half independents (55 percent) in favor and a majority of Republicans (67 percent) opposed. However, the recent increase in support for single-payer has largely been driven by an increase among independents. Among this group, on average in 2008-2009, 42 percent said they would favor a single-payer plan, a share that has increased to a majority (55 percent) in the most recent tracking poll.

Figure 2: Increase in Support for Single-Payer Driven by Independents

“Medicare-for-all” vs. “Single-Payer”

Language often matters in framing questions about health policy. For example, the February 2016 Kaiser Health Tracking Poll found that when terms were tested on their own, outside the definition of a national health plan that would cover all Americans, the public was more likely to react favorably to the term “Medicare-for-all” (64 percent favorable) than “single-payer health insurance system” (44 percent favorable). However, the current poll finds that when the plan is defined as one in which all Americans would get their insurance from a single government plan, support is similar when the plan was referred to as “Medicare-for-all” (57 percent in favor) as when it was referred to as “single payer” (53 percent).

Figure 3: Majority Favors National Health Plan Regardless of a “Single-Payer” or “Medicare-for-All” Label

Support for Single-Payer is Malleable When Given Opposing Arguments

The poll finds the public’s attitudes on single-payer are quite malleable
While a slim majority favors the idea of a national health plan at the outset, a prolonged national debate over making such a dramatic change to the U.S. health care system would likely result in the public being exposed to multiple messages for and against such a plan. The poll finds the public’s attitudes on single-payer are quite malleable, and some people could be convinced to change their position after hearing typical pro and con arguments that might come up in a national debate. For example, when those who initially say they favor a single-payer or Medicare-for-all plan are asked how they would feel if they heard that such a plan would give the government too much control over health care, about four in ten (21 percent of the public overall) say they would change their mind and would now oppose the plan, pushing total opposition up to 62 percent. Similarly, when this group is told such a plan would require many Americans to pay more in taxes or that it would eliminate or replace the Affordable Care Act, total opposition increases to 60 percent and 53 percent, respectively.

Figure 4: Arguments Against Single Payer Plan Sway Some Initial Supporters

On the other side, when those who initially oppose a single-payer or Medicare-for-all plan are asked how they would feel if they heard such a plan would reduce health insurance administrative costs, four in ten (17 percent of the public overall) change their position and say they would now favor the plan, bringing total support to 72 percent. Similarly, when this group is told such a plan would ensure that all Americans have health insurance as a basic right or that it would reduce the role of private health insurance companies in health care, total support increases to 71 percent and 65 percent, respectively.

Figure 5: Arguments in Favor of Single Payer Plan Sway Some Initial Opponents

Article link: http://www.kff.org/health-reform/poll-finding/data-note-modestly-strong-but-malleable-support-for-single-payer-health-care/?utm_campaign=KFF-2017-polling-surveys&utm_content=59483160&utm_medium=social&utm_source=twitter

The San Diego-based vendor scorned the VA for not conducting a competitive bidding process and alleged there is ample time for other EHR vendors to compete for the contract.

By Jessica Davis  August 22, 2017  03:39 PM

San Diego-based electronic health record vendor CliniComp has filed a bid protest with the U.S. Court of Federal Claims against the Department of Veterans Affairs for allegedly awarding Cerner a contract for its new EHR without conducting a competitive bidding process.

CliniComp has provided EHR systems to the U.S. Department of Defense and some VA hospitals since 2009. However, VA Secretary David Shulkin announced in June that the VA would award Cerner a sole contract to replace its legacy VistA EHR system with a Cerner EHR.

[Also: How Jared Kushner helped the VA pick Cerner… quickly]

CliniComp said it filed an agency-level protest to contest the sole source award shortly after the announcement, according to the complaint. But the VA Deputy Assistant Secretary for Acquisition denied the protest on Aug. 7. In doing so, the VA violated the Competition in Contracting Act of 1978, the company claims.

Shulkin has told Congress that the price for the EHR has not yet been negotiated. And
CliniComp alleges that this timeframe could be used to open up competition among other vendors. Competitive bidding can also reduce costs associated with an EHR implementation.

“As shown by the nine counts set forth below, the VA’s decision to award a sole-source contract to Cerner is arbitrary, capricious, an abuse of discretion and violates the CICA and Federal Acquisition Regulations,” according to the suit.

[Also: Pew calls on VA to ensure interoperability, patient matching with Cerner EHR]

The VA has been pressed by Congress for many years to replace its outdated system with a modernized, off-the-shelf EHR. Shulkin said in the spring the VA would make its decision about its legacy system in July — but made the announcement a month earlier.

In making the announcement, Shulkin said the agency “does not have sufficient time to allow for full and open competition.”

CliniComp said this statement “lacks a reasonable basis.”

“In the six to eight months to negotiate a sole source contract with Cerner, the VA could hold an accelerated full and open competition for the next generation of EHR,” the company claimed.

Officials from CliniComp and the VA were not immediately available for comment.

Article link: http://www.healthcareitnews.com/news/ehr-vendor-clinicomp-sues-government-over-no-bid-va-contract-cerner

by Kimberly A. Hepner, Carol P. Roth, Elizabeth M. Sloss, Susan M. Paddock, Praise O. Iyiewuare, Martha J. Timmer, Harold Alan Pincus

The U.S. Department of Defense (DoD) strives to maintain a physically and psychologically healthy, mission-ready force, and the care provided by the Military Health System (MHS) is critical to meeting this goal. Attention has been directed to ensuring the quality and availability of programs and services for posttraumatic stress disorder (PTSD) and depression. This report is a comprehensive assessment of the quality of care delivered by the MHS in 2013–2014 for over 38,000 active-component service members with PTSD or depression. The assessment includes performance on 30 quality measures to evaluate the receipt of recommended assessments and treatments. These measures draw on multiple data sources including administrative encounter data, medical record review data, and patient self-reported outcome monitoring data. The assessment identified strengths and areas for improvement for the MHS. In particular, the MHS excels at screening for suicide risk and substance use, but rates of appropriate follow-up for service members with suicide risk are lower. Most service members received at least some psychotherapy, but less than half of psychotherapy delivered was evidence-based. In analyses focused on Army soldiers, outcome monitoring increased notably over time, yet preliminary analyses suggest that more work is needed to ensure that services are effective in reducing symptoms. When comparing performance between 2012–2013 and 2013–2014, most measures demonstrated slight improvement, but targeted efforts will be needed to support further improvements. RAND provides recommendations for strategies to improve the quality of care delivered for these conditions.

Key Findings

Recommendations

Article link: https://www.rand.org/pubs/research_reports/RR1542.html?adbsc=social_20170819_1715911&adbid=898976864525365248&adbpl=tw&adbpr=22545453

Economic View

By ROBERT H. FRANK JULY 7, 2017

The total cost of providing health coverage under the single-payer approach is actually substantially lower than under the current system in the United States. Credit Christophe Vorlet  

Lingering uncertainty about the fate of the Affordable Care Act has spurred the California legislature to consider adoption of a statewide single-payer health care system.

Sometimes described as Medicare for all, single-payer is a system in which a public agency handles health care financing while the delivery of care remains largely in private hands.

Discussions of the California measure have stalled, however, in the wake of preliminary estimates pegging the cost of the program as greater than the entire state government budget. Similar cost concerns derailed single-payer proposals in Colorado and Vermont.

Voters need to understand that this cost objection is specious. That’s because, as experience in many countries has demonstrated, the total cost of providing health coverage under the single-payer approach is actually substantially lower than under the current system in the United States. It is a bedrock economic principle that if we can find a way to

By analogy, suppose that your state’s government took over road maintenance from the county governments within it, in the process reducing total maintenance costs by 30 percent. Your state taxes would obviously have to go up under this arrangement.

Naval Hospital Oak Harbor in Washington State has transitioned to the MHS GENESIS electronic health record, marking a milestone as the inpatient components are now officially deployed.

By Bill Siwicki July 17, 2017 04:04 PM

Naval Hospital Oak Harbor in Washington State has transitioned to the MHS GENESIS electronic health record from Cerner, the U.S. Department of Defense announced today.

Oak Harbor is the second site to come online as part of the Department of Defense’s initial operating capability program, and the go-live marks a significant milestone as the inpatient components of MHS GENESIS are now officially deployed, wrote Travis Dalton, senior vice president at Cerner, in a Cerner blog post. The first Cerner deployment occurred in February at a clinic at Fairchild Air Force Base.

[Also: DoD says Cerner EHR deployment to reach next milestone in July]

“The integrated system aggregates information into a single EHR, standardized across the branches of the military, to facilitate the safe transition of care across the spectrum of military operations to include garrison, theatre and en route care,” Dalton explained. “At its core, MHS GENESIS is the same commercially available, off-the-shelf electronic medical record that is deployed at thousands of facilities worldwide, operating on one code set.”

Cerner said this creates an integrated and longitudinal patient record and coordination across the continuum of care, regardless of environment, scope and size of military and dental treatment facilities. The ability to integrate and share interoperable patient information with the U.S. Department of Veterans Affairs health care enterprise and civilian health systems is critical and is inherently built into MHS GENISIS, Dalton added.

Naval Hospital Bremerton and Madigan Army Medical Center, both also in Washington State, are slated for the Leidos-led implementation later in 2017, MHS Genesis program executive officer Stacy Cummings said in a statement.

The DoD has promised the U.S. House appropriations committee it will complete deployment at Madigan Army Medical Center by October. The military will conduct tests once the Cerner system is installed at all four bases. It then will conclude if it’s ready to move forward with the remainder of the $4.3 billion Cerner project, slated for completion in 2022.

The Naval Hospital Oak Harbor go-live marks the debut of certain MHS GENESIS capabilities and applications designed, Cerner said, to improve patient safety and clinical efficiency.

According to Dalton, these include a single integrated record across ambulatory, acute and all other venues in the Oak Harbor medical enterprise; medical device interoperability via Cerner’s CareAware medical device connectivity platform; advanced clinical decision support capabilities; advanced specialty provider workflows and embedded clinical calculators; barcode medication administration; and a labor and maternity-specific module designed to create a new infant record upon barcode scan and treatment plans tailored to mother and child.

The U.S. Department of Defense’s MHS GENESIS project encompasses the replacement of three existing EHRs to create a single patient record. It is interoperable with 24 legacy systems and offers improvements designed to save clinicians and patients time, eliminate paper, and reduce potential medical errors and delays, Dalton wrote.

“It’s also engineered to enable interoperability between the private and public sectors,” he added. “MHS GENESIS is designed so that a record can follow a soldier once they leave active military duty or if they visit a civilian health facility.”

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com

Article link: http://www.healthcareitnews.com/news/dod-rolls-out-cerner-ehr-second-military-site

The Office of the Inspector General said will review the accuracy of payments to Medicare hospitals between 2011 and 2016, as well as telemedicine payments.

By Bill Siwicki July 18, 2017 11:41 AM

The Department of Health and Human Services Office of Inspector General will review the accuracy of $14.6 billion in meaningful use payments made to hospitals by Medicare between 2011 and 2016. Earlier this year, the OIG estimated physicians were wrongfully paid $729 million under meaningful use.

Medicare incentive payments were authorized over a 5-year period to hospitals that adopted electronic health record technology. From January 1, 2011, through December 31, 2016, the Centers for Medicare and Medicaid Services made Medicare EHR incentive payments to hospitals totaling $14.6 billion, the OIG said.

[Also: Senators press CMS to recoup EHR overpayments under meaningful use]

The Government Accountability Office identified improper incentive payments as the primary risk to the Medicare EHR incentive program. An OIG report described the obstacles that CMS faces in overseeing the Medicare EHR incentive program. In addition, previous OIG reviews of Medicaid EHR incentive payments found that state agencies overpaid hospitals by $66.7 million and would in the future overpay these hospitals an additional $13.2 million, the OIG said.

“These overpayments resulted from inaccuracies in the hospitals’ calculations of total incentive payments,” the OIG said. “We will review the hospitals’ incentive payment calculations to identify potential overpayments that the hospitals would have received as a result of the inaccuracies.”

[Also: CMS won’t punish eClinicalWorks customers for meaningful use EHR attestations]

On another front, the OIG will be reviewing the accuracy of telemedicine payments under Medicare.

Medicare Part B covers expenses for telehealth services on the telehealth list when those services are delivered via an interactive telecommunications system, provided certain conditions are met. To support rural access to care, Medicare pays for telehealth services provided through live, interactive videoconferencing between a beneficiary located at a rural originating site and a practitioner located at a distant site.

“An eligible originating site must be the practitioner’s office or a specified medical facility, not a beneficiary’s home or office,” the OIG explained. “We will review Medicare claims paid for telehealth services provided at distant sites that do not have corresponding claims from originating sites to determine whether those services met Medicare requirements.”

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com

Article link: http://www.healthcareitnews.com/news/oig-plans-investigate-15-billion-meaningful-use-payments

Just weeks after rumors hinted that Apple is working on a way to bring health records together on iPhones, Amazon appears to have launched an investigation about building EHR software.

By Bernie Monegain  July 27, 2017  04:38 PM

Amazon has started a secret lab at its Seattle headquarters to explore business prospects in the healthcare sector, including EHRs and telemedicine, according CNBC. That report comes on the heels of swirling rumors that Apple is in talks with hospitals and other healthcare organizations to explore the possibility of bringing health records together on the iPhone.

It’s important to note that press reports thus far are based on unnamed sources and industry analysts speculate that even for the likes of Amazon and Apple stealing customers away from Epic, Cerner and Allscripts would likely be a difficult and lengthy process.

Amazon is reportedly considering developing an EHR platform as well as telemedicine and health apps for existing devices, such as its Echo.

[Also: Timeline: How Apple is piecing together its secret healthcare plan]

Amazon has dubbed the covert team “1492,” the year Columbus first landed in the Americas, and it is hiring for positions that are searchable on Amazon using the keyword “a1.492.” The crew is also working on healthcare applications for Amazon devices, such as Echo and Dash Wand.

Apple, for its part, already has a big toe in the healthcare market with its HealthKit and ResearchKit apps, Apple Watch, and work with Health Gorilla to add diagnostic data to the iPhone, including measures such as blood work, by integrating with hospitals, lab test companies and imaging centers.

The Cupertino, California giant has also recently hired people with top healthcare credentials who are savvy in the digital realm.

In seemingly unconnected news, President Trump today announced Apple CEO Tim Cook had promised to build three big manufacturing plants in the U.S. Cook has been mum on the announcement.

Twitter: @Bernie_HITN
Email the writer: bernie.monegain@himssmedia.com

Article link: http://www.healthcareitnews.com/news/wait-what-amazon-and-apple-eye-building-ehrs

Authored by Mr. Nathan P. Freier, Colonel (Ret.) Christopher M. Bado, Dr. Christopher J. Bolan, Colonel (Ret.) Robert S. Hume, Colonel J. Matthew Lissner.

Brief Synopsis

View the Executive Summary

• Added June 29, 2017
• Type: Monograph
• 145 Pages
• Download Format:
  PDF (Recommended)
  Kindle Reader
  ePub (Mobile Devices)
  
• Cost: Free
• Send this page to a colleague.
  
• Alert me when similar studies are published
  
  The U.S. Department of Defense (DoD) faces persistent fundamental change in its strategic and operating environments. This report suggests this reality is the product of the United States entering or being in the midst of a new, more competitive, post-U.S. primacy environment. Post-primacy conditions promise far-reaching impacts on U.S. national security and defense strategy. Consequently, there is an urgent requirement for DoD to examine and adapt how it develops strategy and describes, identifies, assesses, and communicates corporate-level risk. This report takes on the latter risk challenge. It argues for a new post-primacy risk concept and its four governing principles of diversity, dynamism, persistent dialogue, and adaptation. The authors suggest that this approach is critical to maintaining U.S. military advantage into the future. Absent change in current risk convention, the report suggests DoD exposes current and future military performance to potential failure or gross under-performance.

Article link: https://ssi.armywarcollege.edu/pubs/display.cfm?pubID=1358