A Digital Shift on Health Data Swells Profits in an Industry
By JULIE CRESWELL
It was a tantalizing pitch: come get a piece of a $19 billion government “giveaway.”
The approach came in 2009, in a presentation to doctors by Allscripts Healthcare Solutions of Chicago, a well-connected player in the lucrative business of digital medical records. That February, after years of behind-the-scenes lobbying by Allscripts and others, legislation to promote the use of electronic records was signed into law as part of President Obama’s economic stimulus bill. The rewards, Allscripts suggested, were at hand.
But today, as doctors and hospitals struggle to make new records systems work, the clear winners are big companies like Allscripts that lobbied for that legislation and pushed aside smaller competitors.
While proponents say new record-keeping technologies will one day reduce costs and improve care, profits and sales are soaring now across the records industry. At Allscripts, annual sales have more than doubled from $548 million in 2009 to an estimated $1.44 billion last year, partly reflecting daring acquisitions made on the bet that the legislation would be a boon for the industry. At the Cerner Corporation of Kansas City, Mo., sales rose 60 percent during that period. With money pouring in, top executives are enjoying Wall Street-style paydays.
None of that would have happened without the health records legislation that was included in the 2009 economic stimulus bill — and the lobbying that helped produce it. Along the way, the records industry made hundreds of thousands of dollars of political contributions to both Democrats and Republicans. In some cases, the ties went deeper. Glen E. Tullman, until recently the chief executive of Allscripts, was health technology adviser to the 2008 Obama campaign. As C.E.O. of Allscripts, he visited the White House no fewer than seven times after President Obama took office in 2009, according to White House records.
Mr. Tullman, who left Allscripts late last year after a boardroom power struggle, characterized his activities in Washington as an attempt to educate lawmakers and the administration.
“We really haven’t done any lobbying,” Mr. Tullman said in an interview. “I think it’s very common with every administration that when they want to talk about the automotive industry, they convene automotive executives, and when they want to talk about the Internet, they convene Internet executives.”
Losing My Leg to a Medical Error
By FREDERICK S. SOUTHWICK
GAINESVILLE, Fla.
LAST Fourth of July, during a day at the beach, I experienced a sudden pain in my left calf. Two months later, I required an above-the-knee amputation. Compounding my distress was the fact that my doctors had no explanation for why the blood flow to that leg had been cut off. I had none of the usual risk factors for atherosclerosis, the hardening of the arteries. I had low cholesterol and no evidence of diabetes, and I had never smoked. No blood vessels were blocked elsewhere in my body.
It took some further detective work to reveal what must have been the cause. Seventeen years earlier, in 1995, I had surgery on my left Achilles’ tendon. To prevent bleeding during the procedure, a pressurized cuff was placed above my left knee to block the blood flow. Apparently, the cuff was left on too long, injuring the arteries. In the years since, the vessels progressively scarred and calcified, which eventually blocked all blood flow to my lower leg.
I lost my leg because of a preventable error. The loss of a limb is traumatic, and I experience waves of sorrow and regret. I struggle with continual pain in my residual limb, and am trying to learn how to walk with my prosthesis. My work as a physician has been put on hold.
For the past two decades I have been studying how to prevent errors in health care, and the irony of my present predicament strengthens my motivation to continue the quest. No one should ever have to experience such preventable harm.
And yet many people do. Exactly how many, we can’t say, because there is no national registry for injuries or deaths caused by medical errors. Over a decade ago, in the best study of its kind, the Institute of Medicine estimated that there were 44,000 to 98,000 deaths per year because of preventable errors in the American health system. For every death there are likely to be at least 10 serious injuries, so we can assume that roughly a million patients are seriously injured each year.
Despite calls to action by patient advocates and the adoption of safety programs, there is no sign that the numbers of errors, injuries and deaths have improved. Why? Because those responsible for the delivery of health care have been unable to change how they do things.
White House announces health benefits insurers must offer
Posted Feb. 20, 2013, at 4:05 p.m.
WASHINGTON — The Obama administration on Wednesday issued its long-awaited final rule on essential health benefits that insurers must offer consumers in the individual and small-group market beginning in 2014 under the healthcare reform law.
A cornerstone of President Barack Obama’s plan to enhance the breadth of healthcare coverage in the United States, the mandate allows the 50 U.S. states a role in identifying benefit requirements and grants insurers a phased-in accreditation process for plans sold on federal healthcare exchanges.
Wednesday’s rule included few changes from previous administration proposals, a fact that could help states and insurers as they prepare for new online state health insurance marketplaces, known as healthcare exchanges, scheduled to begin enrolling beneficiaries for federally subsidized coverage on Oct. 1.
“The administration has been consistent in its approach to essential health benefits for more than a year, and that continued today. It’s good news for states and insurers because it means they don’t have to make any changes,” said Ian Spatz, a senior healthcare adviser at the consulting firm Manatt Health Solutions.
The exchanges are expected to cover as many as 26 million people within 10 years and seem likely to dominate individual and small group insurance markets. Another 12 million people are expected to receive healthcare coverage through an expansion of the Medicaid program for the poor, according to the nonpartisan Congressional Budget Office.
Obama’s Patient Protection and Affordable Care Act sets out 10 benefit categories that must be covered by most plans at the same level as a typical employer plan. The categories range from hospitalization, prescription drugs and maternity and newborn care.
Insurers including UnitedHealth Group Inc., Aetna Inc. and Cigna Corp. will use the government’s final word on these required benefits as they design plans and set premium prices ahead of the exchange launches. They have each said they will sell plans on some of the exchanges, but have not yet committed to which ones.
UnitedHealth, the largest insurer, said it is still reviewing the new rule. The company said the exchange insurance plans will essentially be a new type of coverage.
“In the long term, we are expecting and preparing for an ‘exchange’ category of coverage to become established as a new benefit category between Medicaid and the traditional commercial benefits markets,” spokesman Daryl Richard said.
The U.S. Department of Health and Human said the rule would mean greater access to mental health and substance abuse services by requiring parity with other healthcare benefits. HHS estimated that 62 million Americans would gain mental health coverage, an issue that has risen in importance after a string of mass shooting including last year’s elementary school massacre in Newtown, Connecticut.
The final rule preserved the state role in determining how the requirements are met by selecting their own benchmarks from plans sold within their respective borders. Most states opted for their home market’s largest small-group plan.
In Reversal, Florida to Take Health Law’s Medicaid Expansion
By LIZETTE ALVAREZ
MIAMI — Gov. Rick Scott of Florida reversed himself on Wednesday and announced that he would expand his state’s Medicaid program to cover the poor, becoming the latest — and, perhaps, most prominent — Republican critic of President Obama’s health care law to decide to put it into effect.
It was an about-face for Mr. Scott, a former businessman who entered politics as a critic of Mr. Obama’s health care proposals. Florida was one of the states that sued to try to block the law. After the Supreme Court ruled last year that though the law was constitutional, states could choose not to expand their Medicaid programs to cover the poor, Mr. Scott said that Florida would not expand its programs.
Mr. Scott said Wednesday that he now supported a three-year expansion of Medicaid, through the period that the federal government has agreed to pay the full cost of the expansion, and before some of the costs are shifted to the states.
“While the federal government is committed to paying 100 percent of the cost, I cannot in good conscience deny Floridians that needed access to health care,” Mr. Scott said at a news conference. “We will support a three-year expansion of the Medicaid program under the new health care law as long as the federal government meets their commitment to pay 100 percent of the cost during that time.”
He said there were “no perfect options” when it came to the Medicaid expansion. “To be clear: our options are either having Floridians pay to fund this program in other states while denying health care to our citizens,” he said, “or using federal funding to help some of the poorest in our state with the Medicaid program as we explore other health care reforms.”
Mr. Scott said the state would not create its own insurance exchange to comply with another provision of the law.
His reversal sent ripples through the nation, especially given the change in tone and substance since the summer, when he said he would not create an exchange or expand Medicaid.
Our M.I.A. Surgeon General
By MARK BITTMAN
When CBS airs its newly commissioned pilot "The Surgeon General," Dr. John Sherman - "the most powerful doctor in the nation" - will become the best-known (albeit fictional) surgeon general since C. Everett Koop. No one I asked (including a member of Congress) could name the current one.
She's Regina Benjamin - and no, I didn't know, either. In theory, the surgeon general is the nation's doctor, an independent practitioner whose major concern is our health. In reality, the position has been eviscerated, and you need not take my word for that.
Six years ago, three former surgeons general - Richard Carmona (who served under the second President Bush), David Satcher (who spanned the Clinton-Bush years), and Koop (who was appointed by Ronald Reagan) - appeared before the House Oversight and Government Reform Committee and declared, in Carmona's words, that the scientific information that they wanted to bring to the American people was being vetted and censored for political reasons, and that he was "often instructed on what to say and not to say."
Six years ago, three former surgeons general - Richard Carmona (who served under the second President Bush), David Satcher (who spanned the Clinton-Bush years), and Koop (who was appointed by Ronald Reagan) - appeared before the House Oversight and Government Reform Committee and declared, in Carmona's words, that the scientific information that they wanted to bring to the American people was being vetted and censored for political reasons, and that he was "often instructed on what to say and not to say."
"We felt," Carmona told me last week, "that science was being politicized. And if the surgeon general is not empowered to state the nonpartisan case based on the best science, then who will?"
Good question. Because it's the surgeon general's job - or should be - to evaluate science and present a considered, impartial recommendation. (Carmona thinks a "State of the Nation's Health" should be a required annual report, like the State of the Union.) Lacking that, there is no official and identifiable spokesperson for the nation's public health, and the obfuscation and confusion sown by Big Food, along with its outright lies and lobbying might, has created a situation in which no one in power will speak the truth: that our diet is making us sick, causing millions of premature deaths each year and driving health care costs through the roof.
One would think these might be areas of concern for the nation's doctor. (And, of course, for the evidently gutless Food and Drug Administration. But that's another story.)
King: Health care – not Medicare, Medicaid – killing us
Maine's junior senator is adamantly opposed to privatizing Social Security and Medicare vouchers.
HALLOWELL — U.S. Sen. Angus King said Wednesday that he won't support privatizing Social Security or instituting a voucher program for Medicare as the federal government seeks ways to reduce spending
"The first thing I want to say, totally clearly and unequivocally: no privatization of Social Security and no voucherization of Medicare," he said.
King spoke to about 50 senior citizens at the Spectrum Generations Cohen Community Center in Hallowell, where the National Committee to Preserve Social Security & Medicare is circulating petitions to urge King and U.S. Sen. Susan Collins, R-Maine, to protect the benefit programs.
King said health care costs in general are the biggest reason for the deficit.
"It's health care expenditures that are killing us," he said. "Not Medicare per se, notMedicaid, but just health care in general. We need to do something about the underlying cost of health care for everybody."
Maine Voices: Health insurance law more of a success than Democrats depict
The reforms now under attack have reduced rate increases and made policies more affordable.
By Rod Whittemore
When is the last time you heard good news about health insurance?
I'm glad to say there's plenty to report, here in Maine, anyway.
The warnings two years ago from Democrats in the Legislature about Maine's new health insurance law were dire: It was going to end health insurance as we know it, making it inaccessible to average Mainers, and send everyone's premiums skyrocketing. In short, a disaster.
As the former chair of the Insurance and Financial Services Committee, and having played a major role in getting this bill out of committee, through the Legislature and onto the governor's desk for his signature, I am proud to tell you just the opposite has happened.
After a decade of becoming accustomed to double-digit increases as high as 19 percent, most Maine businesses are seeing one of two things in their company plans: a significant reduction in the amount of their increase or an actual reduction.
The new law, now known as Public Law 90, was designed to introduce more competition in Maine's health insurance market.
This was achieved, in part, by loosening the community ratings bands that forced insurance companies to charge everyone roughly the same rate, regardless of risk, age group and other factors.
The law also will eventually allow Maine residents to purchase health insurance across state lines, and it prohibits insurance companies from denying coverage because of pre-existing conditions.
The results have been remarkable.
Advocacy group files suit to stop Medicaid cuts set to take effect March 1
Posted Feb. 21, 2013, at 11:54 a.m.
AUGUSTA, Maine — An advocacy group that represents low-income Mainers has filed a lawsuit against the U.S. Department of Health and Human Services in U.S. District Court seeking to block Medicaid cuts for elderly and disabled recipients scheduled to take effect March 1.
Maine Equal Justice Partners, in cooperation with the National Health Law Program and the Center for Medicare Advocacy, filed its request Wednesday for a temporary restraining order on behalf of five Maine residents whose health care coverage through Medicaid would be terminated. On Thursday, the groups asked that the lawsuit be treated as a class action, which would open it to approximately 6,000 Maine residents who stand to lose some or all of their Medicaid coverage as a results of cuts proposed by Gov. Paul LePage’s administration, according to Jack Comart, litigation director for MEJP.
In January, the U.S. Department of Health and Human Services allowed some of the cuts the LePage administration requested last year as a way of coping with a Maine Department of Health and Human Services budget shortfall.
The plaintiffs in the suit are Louis and Katherine Bourgoin, both of Lewiston, Heidi Brooks of Lewiston, Katherine Sherrard of Kennebunk and Donna Stevens of Waterville. All are between 42 and 67 years old and disabled, according a news release from MEJP.
The plaintiffs and their representatives are scheduled to confer with U.S District Court Judge John Woodcock in Portland on Friday, Comart said.
“Federal law protects low-income people and people with disabilities from losing their health insurance coverage through Medicaid,” Comart said Thursday in a prepared statement. “By granting Maine permission to reduce eligibility, the secretary of Health and Human Services has violated the law by cutting health care benefits for people with disabilities and for low-income seniors. Those actions are unacceptable.”
Maine Equal Justice Partners plans to argue that eliminating coverage for the plaintiffs and other Maine residents who qualify for Medicaid under similar circumstances would violate the “maintenance of effort” section of the Affordable Care Act, which largely prohibits states from scaling back existing Medicaid services in advance of the law’s major expansion of Medicaid in 2014. Medicaid is a joint state and federal program that provides health insurance for low-income and some disabled people.
Walmart health kiosks touted as part of ‘self-service revolution’
Posted Feb. 20, 2013, at 10:08 a.m.
STERLING, Va. – Perched by a computer monitor wedged between shelves of cough drops and the pharmacy in a bustling Walmart, Mohamed Khader taps out answers to questions such as how often he eats vegetables, whether anyone in his family has diabetes and his age.
He tests his eyesight, weighs himself and checks his blood pressure as a middle-aged couple watches at the blue-and-white SoloHealth station advertising “free health screenings.”
“You may not go to the doctor every year, but you come to Walmart often,” says the fit-looking 43-year-old Khader who lives in nearby Ashburn, Va. “I get bored while my wife is shopping. This is a time killer. I’ll come back in two months or so, and track my results.”
A burgeoning consumer health industry is betting that millions of consumers will do just that.
As Americans gain coverage under the federal health law, putting increased demand on primary care doctors and spurring interest in cheaper, more convenient care, unmanned kiosks like these may be part of what their manufacturer bills as a “self-service healthcare revolution.”
From SoloHealth’s stations, slated to be in 2,500 Walmarts and Sam’s Clubs next month, to video consultations with doctors, to smartphone apps that track blood pressure and heart rate, consumer health technology is attracting big-name backers such as retailer Walmart, health insurers Wellpoint and UnitedHealthcare and companies that make or distribute medical products, such as Johnson & Johnson and Cardinal Health.
Walmart’s interest is especially significant, given the giant retailer’s reach, the growth of its pharmacies and retail medical clinics and a top official’s recent statements — since walked back by the company — outlining plans for a push into primary care.
Some doctors’ groups and consumer advocates urge caution, raising concerns about how companies might use personal health data, the quality of their medical information and whether advertisers and other sponsors might shape their advice and referrals for commercial reasons.
“There is a trend in general by retailers and health insurers to provide ‘fluff’ to consumers in the guise of real medical information as an advertising delivery device,” says Carmen Balber of the left leaning advocacy group Consumer Watchdog.
Bringing exam rooms to patients
Walmart spokeswoman Danit Marquardt says the placement of SoloHealth stations in many stores is part of the retailer’s commitment to “testing new products and services and ways to keep customers healthy.”
U.S. to operate 26 state health exchanges, including Maine’s, with little local help
Posted Feb. 19, 2013, at 6:39 p.m.
WASHINGTON — The Obama administration said on Tuesday that it will operate federal online health insurance marketplaces in 26 of the 50 U.S. states, including Maine, with little or no input from local state officials.
The U.S. Department of Health and Human Services announced that a total of 24 states, including six with Republican governors, plus the District of Columbia, are on track to run their own marketplaces, known as healthcare exchanges, or to do so in partnership with the federal government.
The new tally, which follows a Feb. 15 deadline for states to request a federal partnership exchange, underscores the logistical challenge facing the administration as it moves to set up federal marketplaces less than eight months before the Oct. 1 opening of plan enrollment.
Gov. Paul LePage has said Maine isn’t interested in setting up its own exchange and will leave it to the federal government.
“I’m not lifting a finger,” he told a Bloomberg reporter at a Republican Governors Association meeting in Las Vegas in November. “We’re not going to get involved. We’re going to let Mr. Obama do a federal exchange. It’s his bill.”
“No matter where a qualified consumer lives, he or she will have access to coverage through a marketplace,” Health and Human Services Secretary Kathleen Sebelius said in a government blog post.
She also emphasized that states which have not opted for a state-run or federal partnership exchange will still be able to apply to run their own in future years.
The exchanges, which are being set up under President Barack Obama’s 2010 healthcare reform law, will offer federally subsidized private health insurance to working families that qualify for assistance. An estimated 26 million people, many of them now uninsured, are expected to obtain coverage through a healthcare exchange over the next 10 years.
But the exchange plan, like other provisions of the Patient Protection and Affordable Care Act, has met with resistance from states, mainly those with Republican leadership. An administration plan to expand the Medicaid program for the poor to another 12 million people also faces stiff Republican opposition among states.
HHS said on Tuesday that it received new applications for federal partnership exchanges from Iowa, Michigan, New Hampshire and West Virginia. Three other states — Delaware, Illinois and Arkansas — already have partnership exchanges in the works.
Sixteen states and the District of Columbia are moving to operate their own online marketplaces, while Utah is asking the government to certify its existing exchange for small groups.
Partnership exchanges allow state officials to have a role in qualifying insurance plans, determining beneficiary eligibility or both.
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