Convenience And Efficiency Fuel Boom In Retail Clinics

Enlarge Mike Derer/AP

Shanda Johnson, right, a nurse practitioner, interviews patient Bill Gilligan at a MinuteClinic at the CVS drug store in North Brunswick, N.J.

Mike Derer/AP

Shanda Johnson, right, a nurse practitioner, interviews patient Bill Gilligan at a MinuteClinic at the CVS drug store in North Brunswick, N.J.

For years, there's been a debate about how walk-in clinics at stores fit into the health care mix. Are they an adequate substitute for a visit to the doctor?

Through it all, the number of clinics has kept growing, numbering 1,355 at the beginning of 2012, a 10.4 percent annual increase, according to consultants Merchant Medicine.

MinuteClinic, a division of CVS Caremark and the largest clinic operator by far, is on track to nearly double the number of clinics it operates to 1,000 by 2016.

The companies expect plenty of demand. "We have a primary care shortage," says Tom Charland, CEO of Merchant Medicine. The operators of clinics, he says, are "betting on the extra capacity they have with their nurse practitioners, who in many states practice with the full authority of a doctor."

 

In addition, by expanding the number of MinuteClinics, which are located inside CVS drugstores, the company increases foot traffic and potential sales of medicines and other merchandise.

There's another big factor in walk-in clinics' favor, says MinuteClinic President Andrew Sussman, in an interview about plans for the clinics. A clinic can provide care at less expense than a doctor's office, urgent care center or hospital emergency room, he says.

A 2009 study by researchers at the Rand Corp. found that the cost to treat three common illnesses � sore throat, ear infection and urinary tract infection � was at least 30 percent lower at a walk-in retail clinic than in other settings.

A walk-in clinic visit, including follow-up care, cost $110, on average, according to the study. That compared with $156 at a physician's office, $166 at an urgent care clinic and $570 at an emergency department. The quality of care was at least as good in a retail clinic as in other settings, the study found.

To be sure, not all clinics succeed. Some close, even as others open up. Merchant Medicine's June report on the state of the industry put the total number of clinics at 1,357, a decline of of eight from the previous month.

Even so, clinics' ability to provide routine care cheaply may make them especially attractive to hospitals and physicians that are forming accountable care organizations, say experts. Under these alliances, providers agree to take responsibility and get paid for keeping a group of people healthy rather than providing services a la carte. They share in any cost savings they achieve.

"If physicians are being paid not by the volume of services but on keeping people healthy, then they might embrace retail clinics," Charland says.

If the individual mandate’s struck down, what next?

In Sunday's edition of the New York Times, blogger Maggie Mahar responded briefly to the question, "What would the future hold if the Supreme Court strikes down the most controversial part of the health care law, the individual mandate?" We asked Mahar to elaborate on the question in this post.

Betting the individual mandate will be upheld

If the Affordable Care Act's individual mandate is ruled unconstitutional by the Supreme Court this month, Maggie Mahar says, the government will have to take a carrot-and-stick approach to attracting healthy Americans to buy individual insurance - and it will likely have to focus much more on carrots.

Ezekiel Emanuel says he has been betting on how the Supreme Court will decide the case challenging the constitutionality of the Patient Protection and Affordable Care Act�(PPACA).

Speaking at the annual meeting of the Jewish Social Policy Action Network in Philadelphia not long ago, Emanuel, who served as Special Advisor on Health Policy to the Obama administration when the bill was being drafted, confided that he has placed five wagers expressing his optimism that "the mandate will survive" along with the rest of the legislation.

"I think the vote will be 6:3 in favor with Kennedy and Roberts voting for."�There is "No doubt it is constitutional," he declared. "Legally, this is an open and shut case."

Emanuel, now chair of the Department of Medical Ethics and Vice Provost for Global Initiatives at the University of Pennsylvania, also revealed that he recently had dinner with Supreme Court Justice Antonin Scalia. Emanuel says Scalia will not vote for the reform bill. (No surprise there.)

For reasons I have explained in earlier posts here and here, I tend to share Emanuel's optimism. Nevertheless, I could easily be wrong.

As Emanuel observes, there remains the danger that the Justices will overturn the mandate. In that case, the vote "will be 5:4 against. If that happens, the country will have bigger problems because then it will be a partisan ruling along party lines," he noted, referring to polls showing that the American public is losing confidence in the integrity of the Supreme Court as an institution that stands above the political fray.

Fat carrots and skinny sticks

If the Justices do declare the mandate unconstitutional, what happens next? Will this spell the end of reform? Absolutely not.

The goal of the mandate is to draw more healthy people into the insurance pool, so that the cost of care when we become sick can be spread over a larger group. But the mandate is only one of many provisions in the PPACA that makes health insurance more attractive and more affordable.

Here are some of the "carrots" that should draw people into the pool:

Under the law, middle-income and low-income families purchasing their own insurance will receive tax credits to help them pay premiums. The subsidies will be calculated on a sliding scale for households with income up to four times the poverty level ($92,200 for a family of four and $44,680 for a single person).The PPACA limits how much insurers can ask patients to pay out-of-pocket.Insurers selling policies to individuals and small groups will have to cover all "essential benefits." No more "Swiss cheese" policies filled with holes.Insurers won't be able to hike your premiums because you're sick.They also won't be able to charge you 30 percent more simply because you are a woman.When covering a large group, insurers must pay out 85 percent of the premiums they collect for medical care. When insuring a small group, administrative costs are higher, so they can keep 20 percent. If they don't spend the required percentage of premiums on care, customers will receive refunds.There will be no co-pays for preventive care, and the deductible will not apply.

These provisions should encourage many young, healthy Americans to purchase insurance. Research shows that younger people don't buy insurance � not because they think they're invincible, but because they can't afford it. Subsidies will help many of them.

Making the hard sell

But the majority of Americans are totally unaware of the ways that reform makes insurance more affordable and more attractive.�This is why Washington & Lee Law Professor Timothy Jost suggests that if the mandate is overturned, reformers should launch "an aggressive, televised marketing campaign." As Jost explained to me in a recent phone interview, "if you really look at who is subject to the mandate, a lot would have every reason in the world to get insurance, and no reason not to even if there is no mandate."

Would the carrots be as effective as the financial penalties in persuading healthy people to buy insurance? Probably not. Many observers argue that without the penalties, people just won't sign up ��no matter how many carrots you dangle under their noses.

I'm not convinced. It's impossible to predict human behavior, especially over a period of years. It remains to be seen how younger Americans will respond to the tax credits, and the rules that require insurers to offer more comprehensive protection, including maternity benefits and preventive care without co-pays.

Moreover, if you read the PPACA, the mandate was a pretty skinny stick. Those who oppose the mandate object that it "forces" Americans to buy insurance. But the truth is that in 2014, someone who decides to opt out would pay a fine of just $95 or 1 percent of taxable income ��whichever is higher � up to $285 per household.

This hardly constitutes "force." Even in 2016, when the penalty peaks, it amounts to only $695 or 2.5 percent of taxable income, up to $2,086 per household ��much less than the cost of insurance.

No question, if the mandate is eliminated, fewer people will be insured. But if reformers do a good job of communicating the benefits of reform, they could draw millions into the pool.

Losing the mandate may not be nearly as great a blow to reform as some suggest.

Note to readers: I welcome reader comments and questions, and will try my best to reply in a timely manner. I ask only that you do your part to keep our discussion both reasoned and polite. � MM� ��

Virtual teaching hospital aims to transform medical training

LEICESTER, England – A computer system enabling medical students to practice diagnosing and managing patients in simulations using real patient data is being developed in an interdepartmental collaborative project between UK-based Leicester Medical School and the Computer Science Department at the University of Leicester.

The software development, led by Professor Reiko Heckel in collaboration with Dr John Barry Omara, will improve supervision of medical students during their clinical placements and provide feedback on their diagnoses and treatment choices through a Web-based medical decision support system.

The way it is designed to work is that in simulated context, medical students will talk to patients and put the clinical symptoms signs and laboratory or radiological data into the system, which then makes suggestions as to possible diagnoses. The students then have to interpret these suggestions and give reasons for their conclusions.

The project grew from an idea from Dr Omara, part-time lecturer at the School of Medicine, to improve healthcare in rural areas of Africa, and has evolved through a number of past and on-going projects by computer science students. In its present form as a training tool for medical students, it will not be used to treat hospital patients.

The "Virtual Teaching Hospital System" project is carried out in cooperation with Dr Omara and in consultation with the Department of Medical and Social Care Education.

Professor Heckel said: "This is an ongoing series of group projects for second-year computer science students. Five groups of six to eight students each work on the project for one term. We are about to begin another round of group projects this winter to extend and improve the system and we will carry on offering it as an option to our students as long as there is a significant amount of work to do on it.

Dr Omara said: "The project, when implemented, will make it easier to explain and teach the complex process involved in making clinical diagnosis (The Clinical Thinking Process)."

Dr Jonathan Hales, Department of Medical and Social Care Education, said: "The value of the system lies in the way the VTHS can be used by medical students to explore 'what if' scenarios - i.e. 'what if this same patient presented with the same symptoms and signs but also with a temperature (or, but without the abdominal pain)?' The value of the system does not therefore lie solely in its ability to come up with useful differential diagnoses, but in its educational capacity, when used by a thoughtful, questioning, exploratory student."

Convenience And Efficiency Fuel Boom In Retail Clinics

Enlarge Mike Derer/AP

Shanda Johnson, right, a nurse practitioner, interviews patient Bill Gilligan at a MinuteClinic at the CVS drug store in North Brunswick, N.J.

Mike Derer/AP

Shanda Johnson, right, a nurse practitioner, interviews patient Bill Gilligan at a MinuteClinic at the CVS drug store in North Brunswick, N.J.

For years, there's been a debate about how walk-in clinics at stores fit into the health care mix. Are they an adequate substitute for a visit to the doctor?

Through it all, the number of clinics has kept growing, numbering 1,355 at the beginning of 2012, a 10.4 percent annual increase, according to consultants Merchant Medicine.

MinuteClinic, a division of CVS Caremark and the largest clinic operator by far, is on track to nearly double the number of clinics it operates to 1,000 by 2016.

The companies expect plenty of demand. "We have a primary care shortage," says Tom Charland, CEO of Merchant Medicine. The operators of clinics, he says, are "betting on the extra capacity they have with their nurse practitioners, who in many states practice with the full authority of a doctor."

 

In addition, by expanding the number of MinuteClinics, which are located inside CVS drugstores, the company increases foot traffic and potential sales of medicines and other merchandise.

There's another big factor in walk-in clinics' favor, says MinuteClinic President Andrew Sussman, in an interview about plans for the clinics. A clinic can provide care at less expense than a doctor's office, urgent care center or hospital emergency room, he says.

A 2009 study by researchers at the Rand Corp. found that the cost to treat three common illnesses � sore throat, ear infection and urinary tract infection � was at least 30 percent lower at a walk-in retail clinic than in other settings.

A walk-in clinic visit, including follow-up care, cost $110, on average, according to the study. That compared with $156 at a physician's office, $166 at an urgent care clinic and $570 at an emergency department. The quality of care was at least as good in a retail clinic as in other settings, the study found.

To be sure, not all clinics succeed. Some close, even as others open up. Merchant Medicine's June report on the state of the industry put the total number of clinics at 1,357, a decline of of eight from the previous month.

Even so, clinics' ability to provide routine care cheaply may make them especially attractive to hospitals and physicians that are forming accountable care organizations, say experts. Under these alliances, providers agree to take responsibility and get paid for keeping a group of people healthy rather than providing services a la carte. They share in any cost savings they achieve.

"If physicians are being paid not by the volume of services but on keeping people healthy, then they might embrace retail clinics," Charland says.

Countdown To The Supreme Court's Ruling On Health Care

Enlarge Alex Wong/Getty Images

People wait outside the Supreme Court last week for word on the fate of the federal health overhaul law.

Alex Wong/Getty Images

People wait outside the Supreme Court last week for word on the fate of the federal health overhaul law.

Anticipation has reached a fever pitch, and the waiting is almost over.

This week, the Supreme Court is almost certain to issue its decision on the constitutionality of President Obama's health care law. The decision could have far-reaching implications for the legal landscape, the nation's health care system and even the Supreme Court's legacy.

The court will have to answer four distinct legal questions raised by the challenge to the Affordable Care Act. The threshold question is whether the court may decide the case now, or whether it must wait until 2015, when all of its provisions � including the individual mandate � have gone into effect.

 

At oral argument in March, the justices seemed uniformly inclined to decide the case now.

The second question for the court is the one most politicians and political pundits have focused on exclusively: Is the provision requiring virtually all Americans to have health insurance constitutional?

The court will have to determine whether Congress exceeded its powers to regulate commerce by creating a mandate that would force most Americans who aren't otherwise insured to buy coverage,

Related NPR Stories Judging The Health Care Law June 28, 2012

Third is the question of the law's expansion of Medicaid, which adds 17 million more people to the rolls. The states challenging the overhaul law have argued that even though the federal government will pay almost all of the cost, it is still impermissibly coercive.

Finally, the court will decide whether, if any part of the law is unconstitutional, it can be separated out, or whether the entire law has to be invalidated.

How the court will settle these various legal questions is only the first uncertainty. The entire health care system, including insurance companies, is anxiously awaiting a decision that is almost certain to have fundamental ramifications for their business.

Indeed, the only way the court's ruling would have no effect on the health care system would be if the law were upheld in its entirety.

Even striking down just a small piece could have numerous consequences —both intended and unintended.

Many provisions of the law are extremely popular, such as a ban on insurers denying coverage because of pre-existing conditions and the rule, already in place, that allows adult children to remain on their parents' insurance plans until age 26. If the law is struck down,therewill be enormous pressure to keep those provisions in place.

The problem is that without the mandate, insurance companies say they could not afford to accept all comers, especially those with previous medical conditions. As for including adult children on parents' policies, that too could be problematic, for different reasons.

True, some of the biggest insurance companies have vowed to keep this provision in place, but if the court invalidates the law, those additional benefits might be taxable. The law waived a key tax provision to ensure that health insurance benefits are not taxed as income. But without the law, parents may have to pay income taxes on those benefits and employers could face higher payroll taxes.

This scenario would cause "utter confusion" for employers, explained James Klein, president of the American Benefits Council, which represents large-employer health plans and companies that provide services to those plans.

"Because after all, there would be some 24-year-old kids who are legal dependents, for whom there would be no income tax owed. And then there would be others for whom they're not legal dependents and so there would be tax that would be owed," he said. "It would be extraordinarily confusing."

The decision could also have a big impact on the court's legacy. If it strikes down the mandate as exceeding Congress' powers under the Constitution, this would be the first time since the New Deal that the court has invalidated a major piece of regulatory legislation.

Already, the case has exposed a major shift in conservative legal thinking. For the last half-century, conservatives, and particularly congressional Republicans, have championed the idea of judicial restraint, arguing that the courts should usually defer to the elected branches. But now, conservatives are explicitly calling for judicial activism. Conservative columnist George Will, for example, wrote this week that "judicial deference to elected representatives can be dereliction of judicial duty."

Can SEIU Help Vermonters Win Single Payer?

While the nation waits for an overdue Supreme Court decision that will decide the fate of President Obama�s Affordable Care Act, another health care drama with wide implications for universal health care is just starting in Vermont.

Prodded by a strong grassroots movement, the Vermont legislature voted last year for a single-payer state health care system where every citizen will eventually be eligible for publicly funded health care.

The new system will take five or six years to fund and implement, however, between phasing out existing insurance arrangements, overcoming legal obstacles, dealing with provisions of the Affordable Care Act, and finding the money to pay for it all.

Meanwhile, the local business community, private insurance companies, and right-wing PACs have regrouped and counterattacked, with non-stop advertising. They�re doing their well-funded best to make sure that single payer never happens in this state or any other. They know that a lot can change, politically and in the state budget, between now and final implementation of Vermont�s health care law, particularly in a state with two-year gubernatorial terms.

Business-Backed Counterattack

Last year�s overhaul was backed by Governor Peter Shumlin, a multimillionaire businessman who faces re-election this year after narrowly winning office in 2010.

Single payer continues to poll well in the state, despite its lack of concrete benefits for even one Vermonter so far�a weakness that conservative opponents are exploiting in their campaign of disinformation and fear-mongering. A recent poll conducted by several Vermont media found nearly 48 percent of those surveyed still favor single payer; 36 percent are opposed.

Shumlin is likely to defeat GOP candidate Randy Brock, whose top adviser is Darcie Johnston, founder of Vermonters for Health Care Freedom, a key conduit for anti-single-payer propaganda, financed by business.

But even if Brock and fellow Shumlin critic Wendy Wilton, who is running for state treasurer, lose this fall, progressives fear they will spread doubt about reform. As a centerpiece of her campaign, Wilton predicts that Vermont will be running budget deficits above $2 billion by 2018 if �Green Mountain Care� becomes a reality. Right-wingers also warn about the new taxes everyone will be required to pay.

�Air War� for Single Payer?

To counter conservative attacks, Shumlin and friends will soon unveil �Vermont Leads: Single Payer Now!,� their own vehicle for advertising and door-to-door canvassing in favor of Green Mountain Care. This new addition to the existing constellation of health care reform groups will spend more than $100,000 on a six-month drive �to engage and activate Vermonters through media and grassroots organizing.�

According to Peter Sterling, an experienced local political operative who was just named director of the group, �more is expected in 2013 for TV ads,� when the legislature reconvenes.

Unfortunately, Vermont Leads doesn�t draw on the formidable grassroots network created since 2008 by the Vermont Workers� Center�and seems designed to bypass the group, which is the state�s most influential single-payer advocate. The VWC�s �Health Care Is a Human Right� Campaign has been widely credited, both locally and nationally, with spearheading the multi-year community-labor mobilization needed to pass the legislation last year.

While working closely with Shumlin and key Democratic legislators to achieve that goal, the Workers� Center has also been willing to sound the alarm and swarm the statehouse when things got off track. Last May, for example, VWC organizers brought more than 1,500 Vermonters to the Capitol to thwart a bid by legislative insiders to exclude undocumented workers from the scope of the law.

The VWC has long received strong backing from unions with members who live and work in Vermont�like the United Electrical Workers, Communications Workers, and Vermont Federation of Nurses and Health Professionals, which bargains for most unionized health care workers in the state.

In contrast, Vermont Leads is being funded by just one union�the 1.9 million-member Service Employees, which has no members working in the state and failed to affiliate the still-independent Vermont State Employees Association more than a decade ago.

�Working with People Who Have Money!�

For Vermont Leads� volunteer board members, SEIU�s sudden arrival, with a wad of cash large by local standards, is cause for some rejoicing. One new recruit is former state AFL-CIO President Jill Charbonneau, a postal worker, who noted in an email to friends that she was �not used to working with people who have money!�

Another Vermont Leads enthusiast is Middlebury College anthropology professor Ellen Oxfeld, who has campaigned under the banner of a small group known as Vermont for Single Payer. SEIU funding is �a gift from heaven,� she told me. �We want to combat the lies, keep up the momentum for single payer, and organize around the financing package� to be adopted by legislators next year.

Deb Richter, leader of Physicians for a National Health Program in Vermont, gave similar reasons for joining Vermont Leads. �We�ve got six more years of fighting to do to keep this on track,� she said. �We now have the ability to spend more for ad campaigns and literature drops. Instead of using existing groups, it made sense to have this one be a separate entity.�

As for SEIU, �they�ve always been single-payer supporters,� Richter asserted. �That�s what I�ve been told.�

Looking a Gift Horse in the Mouth?

Others in single-payer circles wonder whether this particular gift horse could become a Trojan horse that will weaken Vermont�s movement for health care as a human right.

SEIU�s sudden appearance in the state is worrisome to union friends and political allies of the VWC, now in the middle of its own fundraising drive to support an energetic staff of eight who coordinate the work of scores of volunteers around the state.

The VWC is enlisting nationally known figures for a public statement of support titled �Vermont Can Lead the Way.� In an open letter soliciting 1,000 such endorsers, VWC leaders argue that �we will never be able to outspend giant healthcare profiteers and other big money groups in an �air war.� But we can out-organize them on the ground!�

SEIU�s lack of any members on the ground, plus its unhelpful role nationally in health care reform from the Clinton to the Obama eras, has led some labor activists to question its motivation for becoming a single-payer sugar daddy, virtually overnight.

One explanation involves SEIU�s competition with AFSCME to represent personal care attendants in Vermont. Neither union can gain 5,000 new members in that workforce without Shumlin and the legislature agreeing to create a new homecare bargaining unit, plus some sort of card check or election mechanism for union recognition by the state.

And if Shumlin, in the meantime, needs to do some back-pedaling on single payer�under pressure from business interests�SEIU could easily provide political cover for him, local activists fear. For the union, the quid pro quo would be the governor favoring SEIU over AFSCME to represent homecare workers.

Bad Record Elsewhere

Elsewhere in the U.S. and at the federal level, SEIU has undercut other unions� attempts at single-payer legislation (even though its own affiliates have passed many pro-single payer resolutions over the years).

In California, SEIU lobbied against other unions� attempts for single-payer legislation. Then-SEIU President Andy Stern cooked up a plan with Governor Arnold Schwarzenegger that would have required all Californians to buy private insurance but didn�t control the cost of that insurance and set no minimum standards for coverage. Included in the bill was a fund for homecare workers’ health benefits�to be administered by SEIU.

�SEIU played the leading advocacy role and ultimately the lead compromise role on that bill,� California Nurses Association staffer Michael Lighty recalled. “Stern went behind the back of the California State Fed to cut the deal. But it didn’t even pass in the state senate. It lost the backing of labor. It could not withstand the scrutiny.�

In Massachusetts, SEIU affiliates have done little or nothing to build Mass-Care, the main single-payer advocacy organization. Instead, the union worked with Ted Kennedy, then-Governor Mitt Romney, and the coalition known as Health Care for All to enact the state system of mandated private insurance that became the model for the Affordable Care Act.

As one labor friend of Mass-Care notes, �SEIU has been completely absorbed with Romneycare. For them, it�s all about hospital financing, never about changing the system itself.�

Similarly, SEIU helped run interference for the Obama administration when it was working to keep single payer�and ultimately, any public option�off the table in 2009-2010.

Working with liberal foundations and other labor groups, SEIU helped raise $40 million for a group called Health Care for America Now. As David Moberg from In These Times reported, HCAN�s spending swamped that of single-payer groups, while �promoting a strategy closer to Obama’s proposal that would include employer-provided or individually purchased private insurance.�

In 2009, SEIU operatives even intervened at community forums in New Hampshire held to discuss the Affordable Care Act: they tried to prevent local PNHP supporters from distributing pamphlets on single payer.

SEIU�s Man with a Plan

Further fueling suspicions about SEIU�s intentions in Vermont are the multiple hats worn by recently arrived national staffer Matt McDonald. His past assignments have included trying to keep 45,000 Kaiser Permanente hospital workers from fleeing SEIU in California and joining the National Union of Healthcare Workers. In 2010, McDonald was part of an organizing team that engaged in so much misconduct that the National Labor Relations Board overturned the results of that election.

McDonald set up Vermont Leads from scratch, made himself a board member, and hired Sterling as its director. Meanwhile, he is also masterminding SEIU�s attempt to create the new statewide bargaining unit for personal care attendants, an effort that wisely includes wooing advocates for the elderly and disabled who receive such services. (For details on AFSCME�s homecare worker organizing in Vermont, which started before SEIU arrived, see here.)

In response to an email seeking details on SEIU�s homecare organizing plans and the about-to-be-unveiled Vermont Leads, McDonald replied that the questions �threaten the dual goals of creating a single payer system here in Vt., and the eventual unionization of thousands of workers.�

Scramble for New Members

A slugfest between SEIU and AFSCME in Vermont would be a throwback to the frenzied spending contests waged by the same two unions over home-based workers in 2004-2005. In the process of obtaining �organizing rights� deals in Illinois for both childcare and homecare workers�and prevailing over AFSCME there�SEIU became labor�s biggest funder of Rod Blagojevich, the Democratic governor whose illegal �pay to play� schemes landed him in jail for 14 years.

As similar homecare or childcare units unravel in several states under hostile GOP governors, SEIU is now increasingly desperate for new members. A union that was growing by 100,000 annually in 2006-2008 has hit the wall, due to external enemies and its own internal dysfunction.

In 2011, SEIU registered a net gain of only 7,000 members and agency fee-payers, as compared to 59,000 the previous year. So 5,000 new dues payers in Vermont have become a more tempting prize than before, even if they require a costly brawl with an AFL-CIO union that already represents other public workers in the state.

For budgetary reasons, Vermont�s Democratic-controlled legislature balked at creating a new statewide bargaining unit for publicly funded day care providers earlier this year. This was a major, but hopefully not permanent, setback for the Teachers (AFT), the state�s largest AFL-CIO union.

But Shumlin�s passive role and the opposition of key Democratic legislators doesn�t bode well for AFSCME or SEIU doing much better in homecare, as long as the two unions remain divided.

Price of a Relationship

The prospect of a homecare union war is not appealing to others in Vermont labor, for multiple reasons.

�In my opinion, SEIU seems to be cultivating a direct relationship with our governor by loyally supporting his health care plan�including all the expected compromises and retreats that may lie ahead,� says Traven Leyshon, secretary-treasurer of the Vermont AFL-CIO. �This will create real problems for any of us pushing for a stronger, more progressively financed single-payer system than Shumlin favors.�

Ellen David Friedman, a founder of the Vermont Progressive Party and past organizer for the National Education Association in the state, agrees. �SEIU makes very short-term and opportunistic calculations,� David Friedman said. �They will help Shumlin get re-elected in exchange for legislation authorizing homecare unionization. My guess is that his position on single payer really doesn�t matter much to them, since they�ve never really fought for it anywhere else.�

State Senator Anthony Pollina, a Progressive Party leader, worries that the wrong kind of pro-single payer �air war,� funded and directed from out of state, may �encourage right-wing groups to come in and spend even more money.�

According to Pollina, �things could escalate into a media campaign that leaves citizens on the sidelines, just like past single-payer referendum campaigns that were lost in Oregon or California.� Like the Workers� Center, he believes that �progressive grassroots activists can �out-organize� the opposition on the ground but SEIU�s invasion could end up undermining this good work.�

Richter and Oxfeld both insisted they would never let this happen while they served as Vermont Leads board members. �Vermont is a small place,� Richter said. �If it turns out SEIU is trying to push us in a different direction, they won�t have the ground troops to pull it off.� According to Oxfeld, �if they really try to get in the way, I don�t see anyone on the board going along with it.�

Health Care History Repeats?

Three years ago, Michael Lighty from the CNA predicted that creation of a publicly funded model plan, providing universal coverage in an American state, would �move us closer to a single-payer solution� than the �public option� that labor wanted in the Affordable Care Act until President Obama nixed it.

But Lighty warned that �if you pass a plan that�s watered down and bad, you�ve squandered the political moment. You�re going to fuel the cynicism and distrust so many people already have in what can be accomplished in Washington.�

Health care reformers in Vermont are concerned that SEIU will eventually play the same role locally that it did nationally in 2009-2010. If that results in another squandered political moment�this time leaving Vermonters cynical and distrustful about what can be accomplished in Montpelier�the repercussions will be felt in every other state capital where progressives still hope to improve on the Affordable Care Act.

Steve Early is a labor journalist who started writing about Vermont politics when he was a Middlebury College student in 1968. He spent three decades as a New England representative for the Communications Workers, assisting members in Vermont and other states with strikes, contract negotiations, organizing, and health care reform activity. He is the author, most recently, of The Civil Wars in U.S. Labor, from Haymarket Books, and a longtime supporter of the Vermont Workers� Center.

Beacons lead healthcare quality 'revolution'

"We are really at a tipping point here; providers and patients alike have come to realize that the modernization of healthcare is long overdue and that we all have a role in its broad adoption."

So said Jason Kunzman, project officer for the Office of the National Coordinator for Health Information Technology, as he moderated the "Beacon Communities: Leveraging Health IT to Fuel the Quality Revolution" education event at the recent HIMSS 2012 Virtual Conference and Expo. 

The session featured presentations by officials from two Beacon Communities: Southeastern Minnesota (SE MN) Beacon Community and the Keystone Beacon Community of central Pennsylvania. They grappled with the "tipping point" referenced by Kunzman: how has health IT been fueling the quality revolution? Especially, how has it benefited these spotlighted health systems?

Southeastern Minnesota Beacon Community

Chris Chute, MD,, a principal investigator for the SE MN Beacon Community, discussed the IT running through the Beacon system. 

The unique peer-to-peer HIE integrated throughout the community has been central to the community's infrastructure, he said. "This is distinct from most health information exchanges where the health information is the central hub and people subscribe to it. What's different about Southeastern Minnesota Beacon is that we have open-source software – the ONC-provided NwHIN-connect software – that is deployed in each and every provider," Chute said. 

This diversion from a hub-and-spoke model ensures communication and engagement across providers, and the leveraging of a national model: "When we talk about provision of care in Southeastern Minnesota, we are really talking about an integrated network," he said, "and Beacon is the integrating element where all care providers are coordinating and engaged."

Along that strain, the community's public health providers utilize the Public Health Documentation System (PH-Doc) "that is an electronic medical record of public health services," Chute added. PH-Doc integrates information from public health services into the HIE network to outline "community views of ideal health information."

Running parallel to SE MN Beacon's HIE is a comprehensive CDR, said Lacey Hart, program manager for the SE MN Beacon Program. The depository allows for the tracking of clinical and population metrics in the area. To that end, researchers are able to monitor the community workflow and analyze where impacts are being seen. 

Hart stressed data gaps, too, as a key aspect of area metrics highlighted by the advanced repository. "We looked at our data early on - before the repository - and now the data repository is really an excellent way to hone in on where the data gaps exist."

One timely example: SE MN Beacon has been monitoring asthma and diabetes trends, and outlining the clinical measures used to counter the disease. Using the CDR, however, researchers snagged a data hole; "…One of the things we were missing was the patient data," said Hart. Using metrics from the CDR, the Beacon team developed patient centric data gathering tools. The data exchange is now integrated with information on patient lifestyles

Keystone Beacon Community

Like its sibling in Minnesota, the Keystone Beacon Community of Central-PA is using IT to drive care improvements. 

Geisinger Health System, a Pennsylvania-based health services organization, heads the Keystone HIE. The exchange connects 13 member facilities throughout the area. 

The HIE began as a pilot system with three organizations, said Geisinger Health System IT Director and Keystone HIE Director Jim Younkin. It's now linked between 34 organizations. "The services that are being provided through Keystone Beacon include the EHRs being connected," he said. "EHRs now have the ability to publish and consume documents directly from the health information exchange." 

The HIE includes patient and provider portal applications, and supports three distinct models of health exchange: the "pull model," the "send model," and the "push model," said Younkin. 

"We started with the pull model, which is really just using the portal to do a look-up of information," he said. It hinges on "the idea of having a centralized data repository for access by members of the community."

The direct mode allows messaging between site clinicians and patients. 

The push model will be rolled out this month, said Younkin: it allows clinicians "to subscribe to a patient through the health exchange, and then as activity occurs for that patient we can deliver alerts and notifications to those clinicians to inform them of certain activities."

With these various models and the portal applications supported by the Keystone HIE, Younkin says care capability is expanding in central Pennsylvania. 

Similarly, IT has been catalyzing patient provision in the SE MN Beacon Community through HIE and CDR technology. 

IT critical to achieving quality

The communities highlighted in the HIMSS virtual education event only strengthen the case for IT's critical place in fueling the quality revolution, said Kunzman. It's the essential ingredient, he said, in driving providers over that "tipping point" and in the right direction. 

"We are at the end of year two in a three-year journey. Our Beacon Community grantees have made great achievements," said Kunzman. "They've enhanced the role that safety-net providers play in the overall continuum of care, Beacon communities and technology vendors have formed new collaborations in order to introduce efficiency in bringing the most important functionalities to market…"

Vendor Notebook: AeroScout and Futura Mobility partner for RTLS

Futura Mobility has partnered with AeroScout to provide real-time location system (RTLS) technology to hospitals. With the partnership, officials say Futura Mobility will leverage AeroScout’s real-time asset management solutions that deliver location and status of mobile assets and equipment. Key components of the collaboration include temperature and humidity monitoring, patient flow and safety.

Allscripts announced that Summit Medical Group, the largest physician-owned multi-specialty practice in New Jersey, has signed a long-term contract for managed IT services. With Allscripts Managed Services, Summit will focus on its core mission of providing world class patient care while using IT to improve clinical, financial and operational outcomes, officials say.

HID Global announced the production release of its next generation EDGE EVO and VertX EVO controller platform that brings intelligence and decision-making to the door for advanced and highly customizable networked access control solutions. EDGE EVO and VertX EVO offer an open and scalable development platform for the deployment of a wide range of access control functionality, including remote management options, real-time monitoring, report generation and more.

triCerat unveiled the beta version of its Scanect software, a remote scanning technology for healthcare settings that speeds scanning without sacrificing quality or security.
 
SRS announced that Pittsburgh Bone & Joint Surgeons has selected the SRS EHR and PM to replace the system it originally purchased for its seven physicians. PBJS provides high-quality orthopaedic care to the Greater Pittsburgh area of Pennsylvania.

Allscripts announced that Evangelical Community Hospital, in Lewisburg, Pa., has selected its Sunrise EHR system. The hospital already uses Allscripts solutions for its outpatient electronic health record. The addition of the Allscripts Sunrise Clinical Manager solution will help the Hospital migrate its inpatient data and information to an electronic format and provide a seamless and integrated electronic information solution across the hospital, officials say.

Press Ganey Associates and the American Medical Group Association announced the launch of a survey designed to help accountable care organizations (ACOs) and high-performing health systems identify opportunities for improving both efficiency and quality. The AMGA-Press Ganey Coordinated Care Solution, assesses a patient’s entire episode of care and enables better management of population health to create positive patient outcomes and maximize shared savings.

Get Real Consulting announced the launch of the AARP Health Record. The application architected and developed by Get Real, is a secure web based solution designed to empower people over age 50 to manage and improve their own health. This application allows users to enter, store and edit their personal health information in a central location and to selectively share it with caregivers, family members, doctors and other healthcare providers.

InterSystems announced that it has entered into an agreement with Missouri Health Connection for InterSystems HealthShare to be the technology foundation for Missouri Health Connection’s (MHC) statewide health information network. MHC is the state-designated entity chartered to oversee development of Missouri’s statewide health information network.
 
Availity announced the launch of its suite of expanded clinical documentation capabilities, and that four major health plans, seven vendor partners, and multiple physician groups and hospitals are live and successfully utilizing these solutions across its network. The solution suite automates the costly, manual exchange of clinical information needed to support the revenue cycle, as well as emerging value-based payment models and quality improvement programs.

Outcomes Health Information Solutions announced the launch of MA365, a solution that actively drives quality results for Medicare Advantage plans year-round. Launched from a single data platform, MA365 is an integrated suite of solutions that identifies and resolves disparities in care for Medicare Advantage members with the goal of getting needed care for members while also impacting a Medicare Advantage health plan’s Star quality ratings.

MedeAnalytics announced the launch of its Employer Reporting Resource Center. As healthcare expenses have outpaced inflation and revenue growth, companies have struggled to understand the value of their relationships with full-service health plans. Created in response to growing interest by health plans looking to better serve their group and administrative services only (ASO) customers, this resource center has been created to serve as an educational service to the healthcare industry.

Pegasystems announced its next-generation product development and management solution that enables health plans to better meet industry and customer needs by reducing time to market for new insurance and wellness products amid growing healthcare complexity. Pega Product Composer System provides a customer-centric approach to developing and managing innovative healthcare products, supporting product design, approval, operational readiness and implementation.

Virtual teaching hospital aims to transform medical training

LEICESTER, England – A computer system enabling medical students to practice diagnosing and managing patients in simulations using real patient data is being developed in an interdepartmental collaborative project between UK-based Leicester Medical School and the Computer Science Department at the University of Leicester.

The software development, led by Professor Reiko Heckel in collaboration with Dr John Barry Omara, will improve supervision of medical students during their clinical placements and provide feedback on their diagnoses and treatment choices through a Web-based medical decision support system.

The way it is designed to work is that in simulated context, medical students will talk to patients and put the clinical symptoms signs and laboratory or radiological data into the system, which then makes suggestions as to possible diagnoses. The students then have to interpret these suggestions and give reasons for their conclusions.

The project grew from an idea from Dr Omara, part-time lecturer at the School of Medicine, to improve healthcare in rural areas of Africa, and has evolved through a number of past and on-going projects by computer science students. In its present form as a training tool for medical students, it will not be used to treat hospital patients.

The "Virtual Teaching Hospital System" project is carried out in cooperation with Dr Omara and in consultation with the Department of Medical and Social Care Education.

Professor Heckel said: "This is an ongoing series of group projects for second-year computer science students. Five groups of six to eight students each work on the project for one term. We are about to begin another round of group projects this winter to extend and improve the system and we will carry on offering it as an option to our students as long as there is a significant amount of work to do on it.

Dr Omara said: "The project, when implemented, will make it easier to explain and teach the complex process involved in making clinical diagnosis (The Clinical Thinking Process)."

Dr Jonathan Hales, Department of Medical and Social Care Education, said: "The value of the system lies in the way the VTHS can be used by medical students to explore 'what if' scenarios - i.e. 'what if this same patient presented with the same symptoms and signs but also with a temperature (or, but without the abdominal pain)?' The value of the system does not therefore lie solely in its ability to come up with useful differential diagnoses, but in its educational capacity, when used by a thoughtful, questioning, exploratory student."

Protests at White House healthcare hearing in Iowa

By Kay Henderson for Reuters–

DES MOINES, Iowa (Reuters) – The latest White House regional forum on healthcare drew protests and complaints on Monday along with a promise that government-run insurance was at least on the table for discussion.

“Why are we having this shameful event?” said Mona Shaw, a political activist, at the start of the session. “People are dying,” she said, because of what she termed a callous insurance industry.

Iowa Governor Chet Culver who chaired the event cued up a video message from President Barack Obama as security personnel escorted Shaw from the room.

It was the third of five regional meetings which Obama hopes would help Congress figure out how to overhaul the U.S. healthcare system, which is the most expensive in the world even though some 46 million Americans have no health insurance.

Obama plans to make sweeping changes to the system this year to try to cut the number of uninsured while improving the quality of care and controlling costs that are forecast to reach $2.5 trillion dollars this year.

About 20 protesters at the meeting waved signs and chanted “Everybody in, nobody out” — a demand for universal coverage.

Dr. Jess Fiedorowicz, a psychiatrist at the University of Iowa Hospitals who was with the protest group, told the meeting a majority of Americans support a “single payer” or government-run national health insurance program.

“Can we put it on the table for discussion?” Fiedorowicz asked Nancy-Ann De Parle, director of the White House Office on Health Reform.

“Can we study costing? Can we study feasibility of this truly universal, socially just and fiscally responsible alternate to our currently unjust and woefully inefficient system?” Fiedorowicz asked. Many in the crowd applauded.

Vashti Winterburg, 61, co-chair of Kansas Health Care for All, said she opposes any plan that keeps health insurance companies in business.

She said the Kansas nonprofit board she serves on is finding it more and more difficult to pay the premiums of workers who provide in-home care to the elderly.

Chris Peterson, 53, who farms near Clear Lake, Iowa, said he cannot buy private health insurance for his wife or himself two years after his insurance carrier dropped them. They now have $14,000 in medical debt.

From Reuters.com.

No Matter What the Supremes Say, We’re Still SiCKO After All These Years

Come on to Philadelphia on June 30th, if you want to know the low down on what the high court of the land says about health reform. Some real people who serve as the world�s highest profile examples of the dysfunctional healthcare system in the United States, filmmaker Michael Moore, and health insurance industry whistleblower Wendell Potter will converge for an evening of comment and conversation just as the political frenzy over the Supreme Court ruling is announced on the individual mandate for Americans to purchase health insurance that is part of the law passed in 2010.

When the Supreme Court rules, the nation will either continue on the pathway to implementation of the Patient Protection and Affordable Care Act of 2010 (or if you like, and depending on the political flavor, Obamacare/Romneycare) or it will be back to the legislative drawing board to discard and revamp the mess.

The politicos are salivating, and their media friends are right there with them. They can hardly wait to claim their ground even as real people continue to suffer illness, bankruptcy, and death trying to survive illness and injury while the medical-financial-industrial complex grows more bloated and profit-driven every day in America.

But I doubt there really will be much talk about what any of it means to real patients and their families. Except in Philadelphia on June 30th, as eight subjects from Michael Moore�s 2007 documentary, SiCKO, about the broken U.S. healthcare system, Moore himself, and Potter take the stage.

SiCKO turns five at the same time the nation will be buzzing about the political implications of whatever the Supreme Court decides. Those of us who appeared in the film and had our stories recounted for the whole world to see have a perspective that mirrors what families are facing all across the country. Moore selected each of our stories from the tens of thousands he received not because we were so unique but just the opposite � we are representative of thousands and even millions of real Americans just trying to live our lives without interference from insurance company underwriters, utilization review teams, and medical debt collection agencies hired by our doctors and our clinics and hospitals. We told the truth in SiCKO, and we�ll tell the truth again in Philadelphia after the Supreme Court decision.

Michael will be able to offer his own special commentary on the Supremes, and Wendell will give us a view from the dark side � he�ll tell us what the insurance industry insiders are probably thinking and doing in response to the high court�s decisions. It will be an evening of incredible intensity and education.

The SiCKOs so hoped we�d be part of some film archives by now. After the initial rush of our film�s opening and watching ourselves fade back into lives of often quiet desperation and continuation of the struggles that made us perfect fodder for Moore’s work, we stayed in touch with one another as part of a sort of blended family. And we invite you to join that family of Americans who don�t care much what healthcare policy does for one political candidate or another � we care what healthcare policy does for our kids, our grandkids, our parents, our neighbors, our friends and each other.

Join us in Philly (click on the link for more information). Reggie and Billy, 9/11 first responders, Julie Pierce, Dawnelle Keys, Lee Einer, Adrian Campbell Montgomery, Larry and Donna Smith. Still SiCKO. And we�re going to come together to support the work advancing healthcare justice in Vermont and with Healthcare-Now, one of the nation�s great grassroots organizations pushing for expanded and improved Medicare for all.

We�re still SiCKO after all these years, and if we�re going to change that, we�d better claim what we�re up against and get on with the work of making patients the �deciders� and not nine robed judges who will lift their corporate masters no matter which way they have ruled. On the one hand, if the mandate is thrown out, the Romney-ites will go insane with jubilation about the joy to be found in a free-market healthcare system and letting those who have the money get the healthcare needed. On the other hand, if the mandate is upheld, Obama fans will have given the healthcare corporations the hugest bail-out imaginable. For the medical-financial-industrial complex it�s a heads-I-win, tails-you-lose scenario of the highest order.

What say you? What say the patients? What say the families? What say the SiCKOs and our fearless filmmaker, Michael Moore, and his unlikely friend, Wendell Potter? Come on down or up to Philly and let�s get down to the business of real people. See you soon.

'Green lanes' mean 'go' for more cities' cyclists

To boost transit options, U.S. cities are revving up plans for something that has long been popular in Europe � bike lanes protected from traffic.

Separated by curbs, planters, posts or parked cars, these "green lanes" are taking off in � among other cities � Austin, Chicago, Memphis, San Francisco, Portland, Ore., and Washington, D.C.

"We are seeing an explosion of interest in making bicycling stress-free on busy city streets," says Martha Roskowski of Bikes Belong Foundation, a non-profit touting the paths via its Green Lane Project.

She says U.S. cities have had standard bike lanes for decades, but many riders don't see them as safe enough.

"We're promoting a more active lifestyle," says Federal Highway Administrator Victor Mendez, adding that many green lanes are receiving federal funds.

In Chicago on Thursday, he joined officials from several cities to spotlight efforts:

�Texas' Austin, which installed or upgraded 20 to 30 miles of bike lanes in each of the past four years, plans 50 miles this year.

�Memphis, dubbed one of the worst cities for riding by Bicycling magazine in 2008, finished 25 miles of on-street bike trails last year and plans 30 more miles � some of them green lanes � this year.

�Portland, Ore., has built 5 miles of protected bikeways since 2009 and is now working on 4 more miles.

�Chicago, which installed its first protected bike lane last spring on Kinzie Street, has budgeted $40 million to build 100 miles of green lanes by May 2015.

In New York City, some green lanes have drawn opposition because they cut space for driving and parking.

"You have more congestion and frustrated drivers," says Jim Walden, a lawyer with the Gibson Dunn firm who sued against a bike lane on Prospect Park West in Brooklyn that reduced three lanes of traffic to two.

He says contrary to city claims, more crashes and injuries have resulted.

In Washington, D.C., a city survey found bicycling on 15th Street more than doubled since a two-way green lane opened there in 2010. The survey said more cycling crashes occurred, but with ridership up, the accident rate held steady.

Department of Defense signs on with Continua Health Alliance

BEAVERTON, OR – The Department of Defense (DoD) has joined the Continua Health Alliance, which promotes connectivity of personal health devices and advocates for standards-based interoperability guidelines.

On Tuesday, Continua announced that DoD's Joint Program Committee-1, through the U.S. Army Medical Research and Materiel Command, Telemedicine and Advanced Technology Research Center (TATRC), has joined the alliance, an international not-for-profit industry organization, which seeks to advance personal connected health by promoting end-to-end, plug-and-play connectivity.

“Continua is honored to welcome the U.S. Department of Defense to our membership," said Clint McClellan, senior director of strategic marketing at Qualcomm Life, who serves as Continua's board president and chairman. "As a longstanding leader in the development and implementation of connected health strategies, we look forward to working with the Joint Program Committee-1 and TATRC to advance the use of technology to support health and wellness for our Armed Forces and the general public.

“Continua values our partnerships with industry, healthcare provider organizations and government agencies around the globe," he added. "Together, we are working to create an ecosystem of interoperable health technologies to support the convenient and secure collection and sharing of personal health data.”

Joint Program Committee-1 (JPC-1) and TATRC have played a significant role in developing advanced technologies in areas such as health informatics, medical imaging, mobile computing and remote monitoring.

“JPC-1 and TATRC look forward to participating in Continua and assuming an active role in the organization’s working groups to help advance interoperability and the adoption of personal connected health solutions,” added Robert E. Connors, of the Henry M. Jackson Foundation for the Advancement of Military Medicine, and executive health manager at TATRC under the Interpersonnel Government Act.
 

EMRs swift to pinpoint prevention, follow-up care

TORONTO – Primary care practices with electronic medical records identified patients who need preventative or follow-up care approximately 30 times more quickly than paper-based clinics, according to a study commissioned by Canada Health Infoway, a not-for-profit organization funded by the Canadian government.

Researchers from St. Mary's Research Centre, MedbASE Research and McGill University challenged participating clinics to review their patients' records to identify those who would benefit from six different types of evidence-based interventions: immunization, follow-up care after a heart attack, cancer screening, diabetes management and two medication recalls.

[See also: Canada puts up $380M to help docs with EMRs]

"These results demonstrate the value of EMRs in enabling clinicians to deliver high-quality patient care in a timely fashion," said Richard Alvarez, president and CEO of Canada Health Infoway. "The good news is that the number of family physicians using EMRs has grown significantly in recent years, improving quality of care and supporting more efficient care delivery in practices across Canada."
 
Practices using EMRs reviewed the records of all their active patients in an average of 1.4 hours. Paper-based practices of approximately the same size reviewed 10 per cent of all active charts in 3.9 hours, which means that they would have needed an estimated 40 hours to conduct a full practice review.

Practices with EMRs were also more confident in their ability to contact all the right patients to receive the appropriate treatment or intervention in a timely manner. On a scale of one to five, where five is very confident and one is not confident, EMR-based practices were more confident in their reviews than paper-based practices (average score of 3.8 vs. 1.9).

"Using an electronic medical record gives me the peace of mind of knowing I can more quickly identify patients who would benefit from immunizations or other preventive care, as well as those who might be impacted by events such as a medication recall," said Michael Golbey, MD, family physician and chair of Canada Health Infoway's Clinical Council. "Studies such as the practice challenge demonstrate the clinical value that electronic medical records can deliver across Canada."

The basis for the Practice Challenge is an approach to primary care called practice-based population health management. It uses information to help improve care and clinical outcomes across the patients in a given practice. This can include common tasks, such as helping patients with hypertension to manage their condition, or less frequent yet critical tasks, such as a medication recall where timeliness is essential, study officials said. This approach to care has been cited by the College of Family Physicians of Canada as a key element in the transformation of primary care and can help primary care practices to continuously review their services and improve the quality of care that they provide.
 
It is also an approach that Canadians are seeking. In a 2012 Harris Decima survey, 73 per cent of respondents agreed they should receive reminders if preventive or follow-up care is recommended because of their age or health problems. Most of these individuals (85 per cent) indicated that reminders should come from their family doctor or regular place of care.

[See also: Canada launches fight against chronic disease.]

About the challenge
Eleven community-based primary care clinics, including 21 individual physician practices, took part in a one-day Practice Challenge. Seventeen practices used EMRs while four practices used paper-based records. The clinics are located in British Columbia, Ontario, Quebec, Nova Scotia and Newfoundland.
An expert panel of family physicians identified six evidence-based interventions from which specific types of patients could benefit. For each, practices were asked to identify patients in their practice who qualified for that intervention. Those who did not complete the chart review by a set cut-off time recorded the percentage of charts they had reviewed.

The study is a part of a series aimed at understanding the value of EMRs for physicians, patients, and the health system as a whole. Each study is undertaken by academic researchers from across Canada, with support from Canada Health Infoway.

Stress levels increased since 1983, new analysis shows

You may have felt it, but now a scientific analysis of stress over time offers some proof that there's more stress in people's lives today than 25 years ago.

Stress increased 18% for women and 24% for men from 1983 to 2009, according to researchers at Carnegie Mellon University in Pittsburgh, who analyzed data from more than 6,300 people. It's considered the first-ever historical comparison of stress levels across the USA.

"The data suggest there's been an increase in stress over that time," says psychologist and lead author Sheldon Cohen, director of Carnegie Mellon's Laboratory for the Study of Stress, Immunity and Disease. The analysis is published online in the Journal of Applied Social Psychology.

In research done in 1983, 2006 and 2009, those with higher stress were women, people with lower incomes and those with less education. Findings also show that as people age, stress decreases.

"Thirty-year-olds have less stress than 20-year-olds, and 40-year-olds have less stress than 30-year-olds," says Cohen, who has studied the relationship between stress and disease for 35 years.

All three surveys used the Perceived Stress Scale (PSS), a measure Cohen and others created in 1983 to assess the degree to which situations in life are perceived as stressful. Each survey respondent answered a series of questions designed to evaluate their stress levels; researchers used the scale to analyze responses and calculate an overall score. Higher scores indicate greater psychological stress.

Results show increases in stress in almost every demographic category from 1983 to 2009, ranging from 10%-30%.

"Cohen is a good investigator," says psychiatrist David Spiegel, director of the Center on Stress and Health at Stanford University School of Medicine in Stanford, Calif. "He's using a measure of subjective stress."

White, middle-aged men with college degrees and full-time jobs were the group most affected by the economic downturn, the study found. Cohen says that group's increase was almost double that of any other demographic group.

Physician Paul Rosch, president of the non-profit American Institute of Stress, based in Yonkers, N.Y., says this study is more credible than most stress surveys because of its scientific methodology.

And the results make sense, experts say. When you compare the early 1980s to today, "economic pressures are greater, and it's harder to turn off information, and it's harder to buffer ourselves from the world," Spiegel says.

BancTec acquires GTESS claims processing business

IRVING, TX – BancTec, which specializes in financial business process outsourcing, transaction automation and document management, has acquired certain assets of Richardson, Texas-based GTESS, a provider of claims pre-adjudication technology and services for the healthcare industry.

GTESS has served a client base including more than 40 healthcare payers nationwide. BancTec officials say the acquisition – financial terms of which were not disclosed – will enable the firm to strengthen and expand its healthcare claims processing services.

“In this era of healthcare consolidation and reform, health plans and related organizations are under increasing pressure to improve efficiency – but too often are held back by complex, manual pre-adjudication processes,” said Maria L. Allen, senior vice president and president of the Americas at BancTec. “With this addition, BancTec will be able to effectively address this pain point as part of an integrated claims processing offering.”

Founded in 1990, GTESS specializes in automation technologies that drive cost and process improvements in the front-end, or pre-adjudication, portion of healthcare claims processing. This includes the automation of costly, labor-intensive pre-adjudication processes such as provider and member matching and paper claim handling, keying and processing. GTESS has enabled clients to achieve their goals for increased automation, speed and lower costs of claims processing.

“BancTec and GTESS have shared a commitment to superior service and client satisfaction that have stood the test of time,” said Mark King, chairman of GTESS.  “Like GTESS, BancTec provides flexible, focused automation and outsourcing solutions that serve the healthcare industry well. This strategic move gives clients the opportunity to significantly reduce annual expenses by lowering the cost per claim and dramatically improving accuracy, consistency and customer response.”

2012 elections aren’t just about health reform

Harold Pollack and Henry Aaron: GOP health and budget plans would crack pillars of income security for poor and middle-class Americans.

Two years ago, long-frustrated advocates of national health reform rejoiced as Congress passed the Affordable Care Act�(ACA). Before the act was even signed, opponents began a campaign they described as ‘repeal and replace.' This label, it is now clear, is misleading.

There is no agreed ‘replacement' program. "Repeal" would kill expanded coverage for roughly 32 million low- and moderate-income Americans.

There is, however, a GOP program that goes beyond that, to roll back other health protections and roll back federal government activity to levels not seen since the 1930s. Republicans' congressional leaders and their all-but-nominated presidential candidate embrace severe fiscal limits that would pretty much realize Grover Norquist's dream of shrinking the federal government "down to the size where we can drown it in the bathtub."

This program has three pillars, which together may be more important than health reform. Thus far, these pillars have received less scrutiny than they deserve.

Deep tax cuts + spending reductions

The first pillar includes deep tax cuts linked to a balanced budget requirement, a combination that requires massive spending reductions. The tax cuts include elimination of all taxes on long-term capital gains and on much interest and dividends, ending the estate tax, permanent extension of all Bush era tax cuts, and additional rate cuts of 20 percent.

Future spending cuts would be in addition to those Congress approved last year. That round of cuts exempted programs benefitting the poor. Future cuts would target programs benefitting the poor and middle class.

Medicaid cuts

Pillar number two is deep Medicaid cuts and the program's conversion into a block-grant. This policy is embodied in the House Republican Budget resolution, and is endorsed by the Romney campaign.

For five decades, the federal government matched every dollar states spend on Medicaid with one to five dollars. States are required to cover certain essential services for specific needy recipients. The attraction of federal matching funds leads most states to cover additional services such as adult dental care, and to cover additional populations within the ranks of the working poor. The federal match also helps states maintain coverage when recessions cut revenues while needs increase.

The Republicans' program would replace Medicaid's current financing with a fixed payment adjusted to grow more slowly than Medicaid has done. Had this approach been enacted in 2000, reports the Center on Budget and Policy Priorities, Medicaid spending in 2010 would have been 31 percent lower than it actually was. If enacted now, the House Budget committee plan would cut Medicaid expenditures ten years from now by about 34 percent.

Federal payments would not be slated to grow if the number of needy people grew, if the states covered additional services, or if the prices of services rose. Two-thirds of Medicaid spending now serves the elderly and the disabled. Inevitably, eligibility and service coverage would narrow for these groups, along with services to others in economic need.

Medicare voucher program

Pillar number three is the conversion of Medicare from a "defined benefit" to a "defined contribution" program. Medicare now pays for a specific package of medical services. House Republicans would replace this package with a voucher whose value would be tied an economic index, rather than to the actual cost of care. If medical costs outpaced the index, taxpayers would be off the hook, and Medicare beneficiaries would be stuck with the extra costs themselves.

Voucher proponents presume that Medicare enrollees would promote efficiency through aggressive shopping. Evidence for this presumption is sparse and speculative. ACA seeks increased efficiency through health care delivery innovations. While there is some basis for optimism, no one is entirely sure that this approach will work either. Who bears the risk if these costs are not brought under control? Under current law, the general tax payer and Medicare enrollees share that risk. Under the voucher plans, Medicare beneficiaries would shoulder it unaided.

Missing from this menu is any indication of how to deal with Social Security's projected funding gap. Republicans have made clear that they will oppose tax increases to close it. So the only things missing are the details on precisely how they propose to cut future Social Security benefits.

The agenda

The defining characteristics of this agenda are its regressivity and its shifting of cost and risk onto individuals, states, and localities that cannot bear the load. Taxes would go down, disproportionately, for the well-to-do. Spending would decline, disproportionately, for programs that serve the elderly, the disabled, and others in economic need.

This program could become law through the so-called reconciliation process, which requires only simple House and Senate majorities and is not subject to filibuster. Should Mitt Romney win the White House, Republicans would likely win control of the Senate and retain control of the House, bringing these majorities within grasp.

This legislative program is why the 2012 elections are the most important in living memory. Conservatives could achieve goals long in gestation and fervently sought. Liberals could see seventy-five years of social welfare legislation undone.

Voice recognition software helps with MU, doc says

SAN DIEGO – Voice recognition software has provided the means to lower transciption costs, speeding efficiency and populating data for achieving meaningful use, according to Richard Gwinn, MD, director of urgent care at Sharp Rees-Stealy Medical Group in San Diego.

Rees-Stealy Medical Group has 19 locations,400 physicians,1,700 staff members and is one of the largest, most comprehensive medical groups in San Diego County. The group offers primary and specialty care, laboratory, physical therapy, radiology, pharmacy and urgent care.

 [See also: Do doctors have to be typists to get MU incentives?.]

Prior to implementing Nuance Healthcare’s Dragon Medical voice recognition software, providers dictated or hand wrote all documentation, according to Gwinn. Transcribing notes took two to three days and was very costly. Handwriting was faster, but illegible. The group implemented an EHR, but soon found that populating it was too much work.

Two years ago, Rees-Stealy group adopted Nuance's Dragon Medical voice recognition software, and within ten months of implemention, the group went from recording 6,182 progress notes per month in Allscript's Enterprise EHR to 19,020 notes, Gwinn says. Paper chart usage declined from 102,000 per month to 4,000 per month. The group lowered transcription costs by $800,000 to $900,000 annually, representing an 80 to 90 percent reduction.

 "It took me less than one-half hour from the time I first opened Dragon Medical to the time I was using it," Gwinn says."It’s been a life changing application. I go home earlier. I don’t have stacks of charts on my desk and the swelling has gone down in my fingers (from typing).” 

With the advent of meaningful use, many physicians have recognized that while imperative, the task of manually entering data can be time consuming. The adoption of speech-recognition technology has enabled physicians at Dragon Medical to focus more on patient care instead of documentation, Gwinn reports.

Gwinn says the Nuance software has a 99 percent speech recognition rate. "It's wonderful for me, because now I can create charts accurately  and concisely for patients and I can put them in the correct fields and I don't have to touch the mouse, so I can do other things at the same time," Gwinn says.

Gwinn says Rees-Stealy is "among the most advanced groups in the country" when it comes to health IT and electronic health records. In addition, the group does "consistently very well on quality measures."

Physicians were strongly encouraged to use the voice recognition software to populate the EHRs, and most have, but there have been a few holdouts, Gwinn says. 

As for Gwinn, he is 70 years old and wasn't "in the least bit shy about adopting" the software. "I'm very entusiastic about this," he says.

New app maps patients' health risks

WASHINGTON – IndiGO, an application developed by San Francisco-based Archimedes Inc., uses a patient's EHR and advanced algorithms to generate graphical analyses of that individual's health risks. The app brought its game face to last week's Health Data Initiative (HDI) in Washington, D.C., eventually walking away with a win.

IndiGO was presented with the "Best of Care Applications" award at the HDI event earlier this month for its ability to provide a graphical representation of a patient’s heart attack or stroke risk, chance of developing diabetes and the predicted impact of interventions, such as lifestyle changes and medications that are most effective at reducing these risks.

The algorithms that make this possible incorporate clinical evidence related to diseases, behaviors and interventions. IndiGO and individualized guidelines can be used at the point-of-patient care, involving the patient in the decision-making process and improving collaboration between patient and provider. IndiGO is designed for use within ACOs, medical groups, integrated delivery networks (IDN), independent practice associations (IPA) and patient-centered medical homes (PCMH).

"The 'Best of Care Applications' award for IndiGO represents further recognition of the value of clinical decision support, delivered at the point of patient care," said Josh Adler, vice president of Archimedes and IndiGO business leader. "IndiGO's unique capabilities, in the hands of our physician partners, have been found to drive better patient engagement and increase adherence, leading to improved outcomes and lower costs."

The HDI, now guided by the Health Data Consortium, encourages innovators to utilize health data to develop applications to raise awareness of health and health system performance, and spark community action to improve health. Archimedes was one of 17 companies, chosen by a panel of judges from among more than 200 contending companies, to present during the main stage session at Health Datapalooza.

HHS gives 81 innovation awards in second round

WASHINGTON – Health and Human Services Secretary Kathleen Sebelius on Friday announced the recipients of 81 new Health Care Innovation Awardsmade possible by Affordable Care Act. The awards will support innovative projects nationwide designed to deliver high-quality medical care, enhance the health care workforce, and save money.

Combined with the 26 awards announced last month, HHS has distributed money to 107 projects that plan  to save the healthcare system an estimated $1.9 billion over the next three years.?

[See also: HHS gives innovation awards to 26 organizations]

“Thanks to the healthcare law, we are giving people in local communities the resources they need to make our healthcare system stronger,” said Sebelius.
The projects are located in urban and rural areas, all 50 states, the District of Columbia and Puerto Rico. 

Two examples of projects include:
Sepsis Early Recognition and Response Initiative in Texas:  Led by the Methodist Hospital Research Institute in Houston, the program takes a novel approach to identify and treat sepsis before it progresses. Sepsis is the sixth most common reason for hospitalization and typically requires double the average time in the hospital. It leads to complications such as renal failure and cognitive decline. One out of 20 patients with sepsis die within 30 days. Methodist Hospital’s initiative is designed  to reduce the cases of organ failure, improve patient outcomes, lead to shorter hospital stay and lower costs.
Regional Emergency Medical Services in Nevada – along with the Renown Medical Group, the University of Nevada, the Reno School of Community Health Sciences, the Wahoe County Health District, and Nevada‘s Office of Emergency Medical Services – is establishing a new non-emergency phone number for Community Health Early Intervention Teams that will help people get fast and appropriate care, reduce unnecessary hospitalizations, and lower costs.

Awardees were chosen for their innovative solutions to the healthcare challenges facing their communities and for their focus on creating a well-trained healthcare workforce that is equipped to meet the need for new jobs in the 21st century health care system.

[See also: CMS' Tavenner spotlights innovation]

The Centers for Medicare & Medicaid Services (CMS) at HHS contracted with an external organization with extensive experience in managing independent grant review processes to administer the award review process to ensure an objective review of each application. The Center for Medicare and Medicaid Innovation within CMS will administer the awards through cooperative agreements over three years.

 

E. coli outbreak sickens 14 in six states

An outbreak of a less-common form of E. coli has sickened at least 14 people across six states and killed a 21-month old girl in New Orleans, the Centers for Disease Control and Prevention reports.

As of Friday, state health officials in Alabama, California, Florida, Georgia, Louisiana and Tennessee reported cases of the Shiga toxin-producing E. coli strain called O145. The more commonly known form is E. coli O157:H7. The first illness report came April 15, and the most recent is from June 4, the CDC says.

With E. coli infections, it can take up to two to three weeks from "the beginning of a patient's illness to the confirmation that he or she was part of an outbreak," according to the CDC.

No source of the infection has been identified. State public health officials are interviewing ill persons to obtain information regarding foods they might have eaten and other exposures in the week before illness.

Shiga toxin-producing strains of E. coli usually manifest as illness two to eight days after a person has swallowed the bacteria. Most people develop diarrhea, usually watery and often bloody, and abdominal cramps. Most illnesses resolve on their own within seven days, but some can last longer and be more severe.

Most people recover within a week, but in rare cases, some develop a more severe infection. Hemolytic uremic syndrome, a type of kidney failure, can begin as the diarrhea is improving. HUS can occur in people of any age but is most common in children under 5 years old and the elderly.

Because the source isn't known, health officials can't give consumers specific advice on how to avoid the infection, but in general, E. coli can be prevented using these tips from the CDC:

�Wash hands thoroughly after using the bathroom or changing diapers and before preparing or eating food.

�Wash hands after contact with animals or their environments (at farms, petting zoos, fairs, even your own backyard).

�Cook meats thoroughly. Ground beef and meat that has been needle-tenderized should be cooked to a temperature of at least 160 degrees. It's best to use a thermometer, as color is not a very reliable indicator of "doneness."

�Avoid raw milk, unpasteurized dairy products and unpasteurized juices (such as fresh apple cider).

�Avoid swallowing water when swimming or playing in lakes, ponds, streams, swimming pools and backyard "kiddie" pools.

Passing on Single-Payer Health Care

The following article was printed in the October/November issue of Dollars and Sense magazine.

Passing On Single-Payer Health Care
Union leadership is out of touch with the rank and file�and the public�on health care.

By Jeffrey Muckensturm

A coalition of major labor unions and liberal organizations has recently created what it calls �a national grassroots campaign organizing millions of Americans to win a guarantee of quality, affordable health care for all.�

Health Care for America Now (HCAN) is a project of three major unions, the American Federation of State, County, and Municipal Employees (AFSCME), the Service Employees International Union (SEIU), and the United Food and Commercial Workers (UFCW), along with MoveOn and the Association of Community Organizations for Reform Now (ACORN). Elizabeth Edwards is a spokesperson for the new coalition.

With its $40 million budget, HCAN could put a lot of muscle into the fight for a universal, single-payer system that would make the government the sole insurer (the �single payer� to doctors and hospitals). Unfortunately, instead HCAN favors a mixed public/private system that would allow Americans to �keep your current private insurance plan, pick a new private insurance plan, or join a public health insurance plan.�

While HCAN�s �health care for all� slogan will resonate with labor and the left, the group�s actual proposal has met with a skeptical response from, among others, the California Nurses Association and Physicians for a National Health Program. Both fault HCAN for failing to support the United States National Health Insurance Act (H.R. 676), aka �Medicare for All,� introduced in February by Rep. John Conyers (D-Mich.). The bill now has over 91 co-sponsors.

So why doesn�t HCAN support single-payer? According to Richard Kirsch, HCAN�s national campaign director, �One point of this approach [giving people the choice of private insurance or Medicare] was not to scare people away from reform or to make it easier for the opponents of reform to panic the public.� HCAN apparently thinks single-payer is not popular enough among labor, elected officials, or the public to be politically feasible�but they�re wrong.

H.R. 676 has significant labor support. To date, over 445 labor organizations, including 36 state AFL-CIO chapters, 110 Central Labor Councils, the United Steel Workers, the United Auto Workers, and at least 14 AFSCME and SEIU locals have passed resolutions supporting the bill. Interestingly, both SEIU and AFSCME have passed resolutions supporting H.R. 676 at national conventions, showing that there is strong rank-and-file support for single-payer.

Why? Because H.R. 676 takes health benefits off the bargaining table, allowing labor to focus on other key issues. A position paper from the New Jersey State Industrial Union Council explains: �H.R. 676 can create a real opportunity for white- and blue-collar workers. When negotiating a contract the final two issues always are wages and medical benefits. The benefits will always affect wages, and the employer will cry that their health insurance costs limit their ability to give raises.� With health care a non-issue, unions can concentrate on wages, safety, and organizing more workplaces.

And given the budget crisis states and municipalities across the country are facing, the support of AFSCME�s leadership for HCAN rather than single-payer is particularly questionable. According to the National Conference of State Legislatures, more than 30 states face deficits totaling a projected $40 billion this year. The U.S. Conference of Mayors, representing over 1,000 cities with populations over 30,000, unanimously adopted a resolution supporting H.R. 676, which, in their view, will save municipalities millions. According to Healthcare-NOW!, a national organization founded five years ago (not to be confused with HCAN), even a small city could save millions of dollars.

HCAN seems to be out of touch with the American public as well. People aren�t scared of a national health program�quite the opposite. USA Today reported the results of a December 2007 Associated Press/Yahoo! poll: �Sixty-five percent of those polled said the United States should adopt universal health insurance that covers everyone under a program such as Medicare that is run by the government and financed by taxpayers.�

While mixed public/private plans like Massachusetts� are beset by problems and have left many uninsured and over-charged, single-payer has become increasingly popular. With HCAN�s full support, H.R. 676 could be even closer to becoming reality. It�s our only hope if we truly want quality �health care for all.�

Jeffrey Muckensturm is a freelance writer and activist living in Philadelphia. �He can be reached through www.CityInvincible.org.

Resources: Health Care for America Now, www.healthcareforamericanow.org; Jim Kuhnhenn and Trevor Tompson, �Poll: Economy, Health Care Top Issues,� USA Today, December 28, 2007; Richard Kirsch, �Why Not Single-Payer?,� the Now! Blog, blog.healthcareforamericanow.org, July 15, 2008; New Jersey State Industrial Union Council, �For HR 676 One Plan, One Nation Campaign And Regarding Health Care for America Now The Trojan Horse,� www.healthcare-now.org.

U.S. Olympic Team Sprints Ahead With Electronic Health Records

Andrew Villegas/KHN/iStockphoto.com

Transporting reams of athletes' medical information has become a major burden for the U.S. Olympic Committee, and is one reason it's switching to electronic medical records.

Team USA is used to racing with digital clocks. Now, it's time for digital health records.

The U.S. Olympic Committee is converting to electronic medical records this month for the 700 or so athletes who will be competing in London, as well as about 3,000 other athletes who have been seen by USOC doctors in recent years. Some say this step is a sign that electronic medical records have finally made it to the big time.

Electronic records are gaining momentum across the country, largely because the federal government has encouraged health care providers with financial incentives. But at most, only about a third of hospitals and private-practice doctors have fully functional electronic systems, according to recent estimates.

According to Bill Moreau, the USOC's managing director of sports medicine, the committee decided to transition from paper to electronic once it saw that electronic records could handle the unique needs of Olympians.

"Our patient population is probably � next to the military � the most mobile population of any group in the world," Moreau said. "Our athletes are on different continents in the same week."

 

And even when they are at home, tracking athletes' health is no easy task, with athletes training all over the country � from upstate New York to southern California.

Transporting the reams of medical information has become a major burden for the USOC. Previously, the committee had to gather and ship its records to each Olympic host city and didn't have access to athletes' health information for days at a time.

Paper records also created challenges for coordinating care. The average Olympian has eight different clinicians involved in care, according to Moreau, some of whom are affiliated with the USOC. But about half of the athletes aren't in constant contact with the USOC and its health care providers at all.

According to Jim Corrigan, vice president and general manager of GE Healthcare IT � which created the committee's electronic medial record system � members of Team USA will have their paper records digitally scanned or added manually to the collection. GE's program, called Centricity Practice Solution, is already used by more than 40,000 doctors and hospitals in the U.S., but athletes will get a special version.

The new system is supposed to give USOC medical providers a better overall sense of athletes' readiness for competition, Moreau added. Records will include more thorough monitoring of blood hemoglobin, which is important for performance. The HER system will also track immunizations, for athletes' frequent travel. The USOC will also have specialized forms for injury reports at the Games, and the system will ask for more details than it would ask the average patient.