Four Words That Imperil Health Care Law Were All a Mistake, Writers Now Say
By ROBERT PEAR
WASHINGTON — They are only four words in a 900-page law: “established by the state.”
But it is in the ambiguity of those four words in the Affordable Care Act that opponents found a path to challenge the law, all the way to the Supreme Court.
How those words became the most contentious part of President Obama’s signature domestic accomplishment has been a mystery. Who wrote them, and why? Were they really intended, as the plaintiffs in King v. Burwellclaim, to make the tax subsidies in the law available only in states that established their own health insurancemarketplaces, and not in the three dozen states with federal exchanges?
The answer, from interviews with more than two dozen Democrats and Republicans involved in writing the law, is that the words were a product of shifting politics and a sloppy merging of different versions. Some described the words as “inadvertent,” “inartful” or “a drafting error.” But none supported the contention of the plaintiffs, who are from Virginia.
“I don’t ever recall any distinction between federal and state exchanges in terms of the availability of subsidies,” said Olympia J. Snowe, a former Republican senator from Maine who helped write the Finance Committee version of the bill.
“It was never part of our conversations at any point,” said Ms. Snowe, who voted against the final version of the Senate bill. “Why would we have wanted to deny people subsidies? It was not their fault if their state did not set up an exchange.” The four words, she said, were perhaps “inadvertent language,” adding, “I don’t know how else to explain it.”
Former Senator Jeff Bingaman, Democrat of New Mexico, said there may have been “some sloppiness in the drafting” of the bill. Mr. Bingaman, who was a member of both committees that developed the measure, said he was surprised that the lawsuit had reached the Supreme Court because the words in dispute appeared to be a “drafting error.”
How ACA fuels corporatization of American health
care
By Dr. Philip Caper, Special to the BDN
Posted Nov. 20, 2014, at 11:01 a.m.
A new Harvard study has found that Americans’ trust in the medical profession has dropped
dramatically in recent years and lags behind that in many other wealthy countries. At the same
time, doctors are becoming increasingly unhappy with our profession. In his new memoir, “
Doctored,” Dr. Sandeep Jauhar eloquently explains why: More and more doctors are coming to
view our profession as just another job.
We now have a situation where patients are losing confidence in their doctors, while doctors are
losing confidence in our ability to do the right thing for our patients. We have a health care system
becoming more hostile to doctors and patients and more friendly to health care corporations.
These trends are collateral damage caused by another trend: our increasingly corporatized,
commodified and commercialized U.S. health care “industry” that is being put into hyper drive by
the Affordable Care Act. The ACA is accelerating an ongoing wave of hospital consolidations and
acquisition of doctors’ practices by large corporations, such as Eastern Maine Healthcare Systems
and MaineHealth.
As we continue down this road, doctors see our clinical autonomy disappearing as more and more
of us become corporate employees subject to pressure to meet corporate financial goals that often
differ from what is best for our patients. Patients sense that pressure as they are rushed through
exams and are subject to more tests and procedures, some of them of questionable clinical value.
They can almost hear the cash registers ringing as they move through their doctors’ offices, as more
wealth is transferred from patients to those selling health care goods and services.
Why is American medicine, once the crown jewel of American professionalism and a proud and
respected calling, becoming just another commercial enterprise? In his 2010 book “ Hijacked,” Dr.
John Geyman, chairman emeritus of the department of family practice at the University of
Washington, explains how during the year-long Congressional debate leading up to enactment of
the ACA, the interests of the public, including doctors and patients, were subverted to those of
large health care corporations.
The highjacking of health care reform is paying off handsomely. Robert Pear of the New York
Times recently described how the federal government and the commercial health insurance
industry have morphed into one big fan club for the ACA. He quotes the libertarian Cato Institute’s
Michael Cannon explaining that since the ACA’s enactment, “Insurers and the government have
developed a symbiotic relationship, nurtured by tens of billions of dollars that flow from the federal
Treasury to insurers each year.”
Pear goes on to report that, “Since Mr. Obama signed the law, share prices for four of the major
insurance companies — Aetna, Cigna, Humana and UnitedHealth — have more than doubled,
while the Standard & Poor’s 500-stock index has increased about 70 percent.”
Pharmaceutical companies also have done very well. The ACA contains no authority for the
government to negotiate pharmaceutical prices but continues the federal prohibition on the
importation by U.S. residents of lower priced prescription drugs from many foreign countries.
This situation won’t change anytime soon. Congress is gridlocked. What is widely recognized as a
drafting error in the ACA — which, in saner times, could have been fixed quickly without attracting
much attention — is now headed to the Supreme Court.
Of course, health care is just one of many examples in which the welfare of corporations has been
put ahead of the interests of the public, but it may be the poster child. Health care is now more
than a sixth of our economy, and human lives and dollars are at stake.
Corporate stranglehold of our public policy traces back to the increasingly corrupt way our political
campaigns are financed. The recent midterm elections were a stark reminder of that, setting record
levels for corporate spending, even on local races, and saturating voters with negative, intrusive
and often obnoxious messages.
What’s at stake is the future of health care and many other issues that will determine what kind of a
country our children will live in. That future depends on how active and informed the public is
willing to become in electing public officials who place the welfare of their constituents ahead of
the wishes of their corporate contributors.
The results of the recent elections are not encouraging. But what’s becoming clearer is that our
struggle is not between Democrats and Republicans, liberals and conservatives, or occupiers and
tea partiers. It is between real American people and corporations.
I, for one, intend to continue pointing that out. That’s where our attention should be focused.
http://bangordailynews.com/2014/11/20/health/blogs-and-columns/how-aca-fuels-corporatization-of-american-health-care/
By ROBERT PEAR
WASHINGTON — They are only four words in a 900-page law: “established by the state.”
But it is in the ambiguity of those four words in the Affordable Care Act that opponents found a path to challenge the law, all the way to the Supreme Court.
How those words became the most contentious part of President Obama’s signature domestic accomplishment has been a mystery. Who wrote them, and why? Were they really intended, as the plaintiffs in King v. Burwellclaim, to make the tax subsidies in the law available only in states that established their own health insurancemarketplaces, and not in the three dozen states with federal exchanges?
The answer, from interviews with more than two dozen Democrats and Republicans involved in writing the law, is that the words were a product of shifting politics and a sloppy merging of different versions. Some described the words as “inadvertent,” “inartful” or “a drafting error.” But none supported the contention of the plaintiffs, who are from Virginia.
“I don’t ever recall any distinction between federal and state exchanges in terms of the availability of subsidies,” said Olympia J. Snowe, a former Republican senator from Maine who helped write the Finance Committee version of the bill.
“It was never part of our conversations at any point,” said Ms. Snowe, who voted against the final version of the Senate bill. “Why would we have wanted to deny people subsidies? It was not their fault if their state did not set up an exchange.” The four words, she said, were perhaps “inadvertent language,” adding, “I don’t know how else to explain it.”
Former Senator Jeff Bingaman, Democrat of New Mexico, said there may have been “some sloppiness in the drafting” of the bill. Mr. Bingaman, who was a member of both committees that developed the measure, said he was surprised that the lawsuit had reached the Supreme Court because the words in dispute appeared to be a “drafting error.”
How ACA fuels corporatization of American health
care
By Dr. Philip Caper, Special to the BDN
Posted Nov. 20, 2014, at 11:01 a.m.
A new Harvard study has found that Americans’ trust in the medical profession has dropped dramatically in recent years and lags behind that in many other wealthy countries. At the same time, doctors are becoming increasingly unhappy with our profession. In his new memoir, “ Doctored,” Dr. Sandeep Jauhar eloquently explains why: More and more doctors are coming to view our profession as just another job.
We now have a situation where patients are losing confidence in their doctors, while doctors are losing confidence in our ability to do the right thing for our patients. We have a health care system becoming more hostile to doctors and patients and more friendly to health care corporations.
These trends are collateral damage caused by another trend: our increasingly corporatized, commodified and commercialized U.S. health care “industry” that is being put into hyper drive by the Affordable Care Act. The ACA is accelerating an ongoing wave of hospital consolidations and acquisition of doctors’ practices by large corporations, such as Eastern Maine Healthcare Systems and MaineHealth.
As we continue down this road, doctors see our clinical autonomy disappearing as more and more of us become corporate employees subject to pressure to meet corporate financial goals that often differ from what is best for our patients. Patients sense that pressure as they are rushed through exams and are subject to more tests and procedures, some of them of questionable clinical value. They can almost hear the cash registers ringing as they move through their doctors’ offices, as more wealth is transferred from patients to those selling health care goods and services.
Why is American medicine, once the crown jewel of American professionalism and a proud and respected calling, becoming just another commercial enterprise? In his 2010 book “ Hijacked,” Dr. John Geyman, chairman emeritus of the department of family practice at the University of Washington, explains how during the year-long Congressional debate leading up to enactment of the ACA, the interests of the public, including doctors and patients, were subverted to those of large health care corporations.
The highjacking of health care reform is paying off handsomely. Robert Pear of the New York Times recently described how the federal government and the commercial health insurance industry have morphed into one big fan club for the ACA. He quotes the libertarian Cato Institute’s
By Dr. Philip Caper, Special to the BDN
Posted Nov. 20, 2014, at 11:01 a.m.
A new Harvard study has found that Americans’ trust in the medical profession has dropped dramatically in recent years and lags behind that in many other wealthy countries. At the same time, doctors are becoming increasingly unhappy with our profession. In his new memoir, “ Doctored,” Dr. Sandeep Jauhar eloquently explains why: More and more doctors are coming to view our profession as just another job.
We now have a situation where patients are losing confidence in their doctors, while doctors are losing confidence in our ability to do the right thing for our patients. We have a health care system becoming more hostile to doctors and patients and more friendly to health care corporations.
These trends are collateral damage caused by another trend: our increasingly corporatized, commodified and commercialized U.S. health care “industry” that is being put into hyper drive by the Affordable Care Act. The ACA is accelerating an ongoing wave of hospital consolidations and acquisition of doctors’ practices by large corporations, such as Eastern Maine Healthcare Systems and MaineHealth.
As we continue down this road, doctors see our clinical autonomy disappearing as more and more of us become corporate employees subject to pressure to meet corporate financial goals that often differ from what is best for our patients. Patients sense that pressure as they are rushed through exams and are subject to more tests and procedures, some of them of questionable clinical value. They can almost hear the cash registers ringing as they move through their doctors’ offices, as more wealth is transferred from patients to those selling health care goods and services.
Why is American medicine, once the crown jewel of American professionalism and a proud and respected calling, becoming just another commercial enterprise? In his 2010 book “ Hijacked,” Dr. John Geyman, chairman emeritus of the department of family practice at the University of Washington, explains how during the year-long Congressional debate leading up to enactment of the ACA, the interests of the public, including doctors and patients, were subverted to those of large health care corporations.
The highjacking of health care reform is paying off handsomely. Robert Pear of the New York Times recently described how the federal government and the commercial health insurance industry have morphed into one big fan club for the ACA. He quotes the libertarian Cato Institute’s
Michael Cannon explaining that since the ACA’s enactment, “Insurers and the government have
developed a symbiotic relationship, nurtured by tens of billions of dollars that flow from the federal
Treasury to insurers each year.”
Pear goes on to report that, “Since Mr. Obama signed the law, share prices for four of the major insurance companies — Aetna, Cigna, Humana and UnitedHealth — have more than doubled, while the Standard & Poor’s 500-stock index has increased about 70 percent.”
Pharmaceutical companies also have done very well. The ACA contains no authority for the government to negotiate pharmaceutical prices but continues the federal prohibition on the importation by U.S. residents of lower priced prescription drugs from many foreign countries.
This situation won’t change anytime soon. Congress is gridlocked. What is widely recognized as a drafting error in the ACA — which, in saner times, could have been fixed quickly without attracting much attention — is now headed to the Supreme Court.
Of course, health care is just one of many examples in which the welfare of corporations has been put ahead of the interests of the public, but it may be the poster child. Health care is now more than a sixth of our economy, and human lives and dollars are at stake.
Corporate stranglehold of our public policy traces back to the increasingly corrupt way our political campaigns are financed. The recent midterm elections were a stark reminder of that, setting record levels for corporate spending, even on local races, and saturating voters with negative, intrusive and often obnoxious messages.
What’s at stake is the future of health care and many other issues that will determine what kind of a country our children will live in. That future depends on how active and informed the public is willing to become in electing public officials who place the welfare of their constituents ahead of the wishes of their corporate contributors.
The results of the recent elections are not encouraging. But what’s becoming clearer is that our struggle is not between Democrats and Republicans, liberals and conservatives, or occupiers and tea partiers. It is between real American people and corporations.
I, for one, intend to continue pointing that out. That’s where our attention should be focused.
http://bangordailynews.com/2014/11/20/health/blogs-and-columns/how-aca-fuels-corporatization-of-american-health-care/
Pear goes on to report that, “Since Mr. Obama signed the law, share prices for four of the major insurance companies — Aetna, Cigna, Humana and UnitedHealth — have more than doubled, while the Standard & Poor’s 500-stock index has increased about 70 percent.”
Pharmaceutical companies also have done very well. The ACA contains no authority for the government to negotiate pharmaceutical prices but continues the federal prohibition on the importation by U.S. residents of lower priced prescription drugs from many foreign countries.
This situation won’t change anytime soon. Congress is gridlocked. What is widely recognized as a drafting error in the ACA — which, in saner times, could have been fixed quickly without attracting much attention — is now headed to the Supreme Court.
Of course, health care is just one of many examples in which the welfare of corporations has been put ahead of the interests of the public, but it may be the poster child. Health care is now more than a sixth of our economy, and human lives and dollars are at stake.
Corporate stranglehold of our public policy traces back to the increasingly corrupt way our political campaigns are financed. The recent midterm elections were a stark reminder of that, setting record levels for corporate spending, even on local races, and saturating voters with negative, intrusive and often obnoxious messages.
What’s at stake is the future of health care and many other issues that will determine what kind of a country our children will live in. That future depends on how active and informed the public is willing to become in electing public officials who place the welfare of their constituents ahead of the wishes of their corporate contributors.
The results of the recent elections are not encouraging. But what’s becoming clearer is that our struggle is not between Democrats and Republicans, liberals and conservatives, or occupiers and tea partiers. It is between real American people and corporations.
I, for one, intend to continue pointing that out. That’s where our attention should be focused.
http://bangordailynews.com/2014/11/20/health/blogs-and-columns/how-aca-fuels-corporatization-of-american-health-care/
Review: ‘The Digital Doctor’ by Robert Wachter Weighs Medicine’s Technological Transformation
Janus was the Roman god of doorways and beginnings, the one depicted in sculpture with two faces on a single head. An elderly face gazes backward. (Fondly? Bitterly? Regretfully? Who knows.) A youthful face looks forward, presumably with resolution and hope.
Janus is the god of medicine these days, and it is the great strength of Dr. Robert Wachter’s eloquent new book (excerpt) that it has captured every one of these conflicting emotions, all powerfully felt and intelligently analyzed.
“The Digital Doctor” is one of several books over the last few years to address the conquest of medicine by digital technology. X-rays on film, handwritten charts, paper prescriptions, stethoscopes — the familiar tools are disappearing fast as time-honored routines are replaced by digital and virtual alternatives.
Most previous authors have chosen sides, either mourning the old or hailing the new. Dr. Wachter is unusual for his equipoise. He is old enough to remember the way things used to work (or fail to work), young enough to be reasonably technology friendly.
A professor of medicine at the University of California, San Francisco, and a past executive for several prominent national medical associations, he still treks around the hospital seeing patients with the resident foot soldiers. He is also an exceptionally good, fluent writer.
The narrative spins off a single anecdote: Two years ago, Dr. Wachter’s top-tier hospital was humming along with an expensive electronic system full of safeguards against every possible form of error, when a gigantic error occurred. A teenager on the pediatric ward received a huge overdose of a common antibiotic.
The disaster would never have happened in an old analog hospital, and Dr. Wachter meticulously probes the digital details that enabled it. He interviews the doctor who unintentionally clicked out an order for 38½ pills instead of one, the pharmacist who signed off on the ridiculous dose (packaged in 39 separate plastic envelopes), the nurse who meticulously opened every envelope, and the perfectly cognizant patient who obediently swallowed them.
What could have made them all collude in such a catastrophe?
Pretty much every highly celebrated feature of electronic medicine did damage. Some were relatively minor and remediable problems like the software involved, which featured tiny type on a busy screen, defaulted to the wrong unit of measurement, and forced the prescriber to choose among various drug options with no ability to construct an order from scratch.
Doctoring, Without the Doctor
WOOD LAKE, Neb. — There are just a handful of psychiatrists in all of western Nebraska, a vast expanse of farmland and cattle ranches. So when Murlene Osburn, a cattle rancher turned psychiatric nurse, finished her graduate degree, she thought starting a practice in this tiny village of tumbleweeds and farm equipment dealerships would be easy.
It wasn’t. A state law required nurses like her to get a doctor to sign off before they performed the tasks for which they were nationally certified. But the only willing psychiatrist she could find was seven hours away by car and wanted to charge her $500 a month. Discouraged, she set the idea for a practice aside and returned to work on her ranch.
“Do you see a psychiatrist around here? I don’t!” said Ms. Osburn, who has lived in Wood Lake, population 63, for 11 years. “I am willing to practice here. They aren’t. It just gets down to that.”
But in March the rules changed: Nebraska became the 20th state to adopt a law that makes it possible for nurses in a variety of medical fields with most advanced degrees to practice without a doctor’s oversight. Maryland’s governor signed a similar bill into law this month, and eight more states are considering such legislation, according to the American Association of Nurse Practitioners. Now nurses in Nebraska with a master’s degree or better, known as nurse practitioners, no longer have to get a signed agreement from a doctor to be able to do what their state license allows — order and interpret diagnostic tests, prescribe medications and administer treatments.
WOOD LAKE, Neb. — There are just a handful of psychiatrists in all of western Nebraska, a vast expanse of farmland and cattle ranches. So when Murlene Osburn, a cattle rancher turned psychiatric nurse, finished her graduate degree, she thought starting a practice in this tiny village of tumbleweeds and farm equipment dealerships would be easy.
It wasn’t. A state law required nurses like her to get a doctor to sign off before they performed the tasks for which they were nationally certified. But the only willing psychiatrist she could find was seven hours away by car and wanted to charge her $500 a month. Discouraged, she set the idea for a practice aside and returned to work on her ranch.
“Do you see a psychiatrist around here? I don’t!” said Ms. Osburn, who has lived in Wood Lake, population 63, for 11 years. “I am willing to practice here. They aren’t. It just gets down to that.”
But in March the rules changed: Nebraska became the 20th state to adopt a law that makes it possible for nurses in a variety of medical fields with most advanced degrees to practice without a doctor’s oversight. Maryland’s governor signed a similar bill into law this month, and eight more states are considering such legislation, according to the American Association of Nurse Practitioners. Now nurses in Nebraska with a master’s degree or better, known as nurse practitioners, no longer have to get a signed agreement from a doctor to be able to do what their state license allows — order and interpret diagnostic tests, prescribe medications and administer treatments.
The University of Minnesota’s Medical Research Mess
By CARL ELLIOTT
MINNEAPOLIS — IF you want to see just how long an academic institution can tolerate a string of slow, festering research scandals, let me invite you to the University of Minnesota, where I teach medical ethics.
Over the past 25 years, our department of psychiatry has been party to the following disgraces: a felony conviction and a Food and Drug Administration research disqualification for a psychiatrist guilty of fraud in a drug study; the F.D.A. disqualification of another psychiatrist, for enrolling illiterate Hmong refugees in a drug study without their consent; the suspended license of yet another psychiatrist, who was charged with “reckless, if not willful, disregard” for dozens of patients; and, in 2004, the discovery, in a halfway house bathroom, of the near-decapitated corpse of Dan Markingson, a seriously mentally ill young man under an involuntary commitment order who committed suicide after enrolling, over the objections of his mother, in an industry-funded antipsychotic study run by members of the department.
And those, unfortunately, are just the highlights.
The problem extends well beyond the department of psychiatry and into the university administration. Rather than dealing forthrightly with these ethical breaches, university officials have seemed more interested in covering up wrongdoing with a variety of underhanded tactics. Reporting in The Star Tribune discovered, for example, that in the felony case, university officials hid an internal investigation of the fraud from federal investigators for nearly four years.
I hope that the situation at the University of Minnesota is exceptional. But I know that at least one underlying cause of our problems is not limited to us: namely, the antiquated bureaucratic apparatus of institutional review boards, or I.R.B.s, which are supposed to protect subjects of medical experimentation. Indeed, whether other institutions have seen the kinds of abuses that have emerged at the University of Minnesota is difficult to know, precisely because the current research oversight system is inadequate to detect them.
The current I.R.B. system of research protection arose in the 1970s. At the time, many reformers believed the main threat to research subjects came from overambitious government and university researchers who might be tempted to overlook the welfare of research subjects.
As a result, the scheme put in place for protecting subjects was not a formal regulatory system but essentially an honor code. Under the I.R.B. system, medical research studies are evaluated — on paper — by a panel of academic volunteers. I.R.B.s do not usually monitor research as it is taking place. They rarely see a research subject or even a researcher face to face. Instead, they simply trust researchers to tell the truth, report mishaps honestly and conduct their studies in the way that they claim to be conducting them.
These days, of course, medical research is not just a scholarly affair. It is also a global, multibillion-dollar business enterprise, powered by the pharmaceutical and medical-device industries. The ethical problem today is not merely that these corporations have plenty of money to grease the wheels of university research. It’s also that researchers themselves are often given powerful financial incentives to do unethical things: pressure vulnerable subjects to enroll in studies, fudge diagnoses to recruit otherwise ineligible subjects and keep subjects in studies even when they are doing poorly.
By CARL ELLIOTT
MINNEAPOLIS — IF you want to see just how long an academic institution can tolerate a string of slow, festering research scandals, let me invite you to the University of Minnesota, where I teach medical ethics.
Over the past 25 years, our department of psychiatry has been party to the following disgraces: a felony conviction and a Food and Drug Administration research disqualification for a psychiatrist guilty of fraud in a drug study; the F.D.A. disqualification of another psychiatrist, for enrolling illiterate Hmong refugees in a drug study without their consent; the suspended license of yet another psychiatrist, who was charged with “reckless, if not willful, disregard” for dozens of patients; and, in 2004, the discovery, in a halfway house bathroom, of the near-decapitated corpse of Dan Markingson, a seriously mentally ill young man under an involuntary commitment order who committed suicide after enrolling, over the objections of his mother, in an industry-funded antipsychotic study run by members of the department.
And those, unfortunately, are just the highlights.
The problem extends well beyond the department of psychiatry and into the university administration. Rather than dealing forthrightly with these ethical breaches, university officials have seemed more interested in covering up wrongdoing with a variety of underhanded tactics. Reporting in The Star Tribune discovered, for example, that in the felony case, university officials hid an internal investigation of the fraud from federal investigators for nearly four years.
I hope that the situation at the University of Minnesota is exceptional. But I know that at least one underlying cause of our problems is not limited to us: namely, the antiquated bureaucratic apparatus of institutional review boards, or I.R.B.s, which are supposed to protect subjects of medical experimentation. Indeed, whether other institutions have seen the kinds of abuses that have emerged at the University of Minnesota is difficult to know, precisely because the current research oversight system is inadequate to detect them.
The current I.R.B. system of research protection arose in the 1970s. At the time, many reformers believed the main threat to research subjects came from overambitious government and university researchers who might be tempted to overlook the welfare of research subjects.
As a result, the scheme put in place for protecting subjects was not a formal regulatory system but essentially an honor code. Under the I.R.B. system, medical research studies are evaluated — on paper — by a panel of academic volunteers. I.R.B.s do not usually monitor research as it is taking place. They rarely see a research subject or even a researcher face to face. Instead, they simply trust researchers to tell the truth, report mishaps honestly and conduct their studies in the way that they claim to be conducting them.
These days, of course, medical research is not just a scholarly affair. It is also a global, multibillion-dollar business enterprise, powered by the pharmaceutical and medical-device industries. The ethical problem today is not merely that these corporations have plenty of money to grease the wheels of university research. It’s also that researchers themselves are often given powerful financial incentives to do unethical things: pressure vulnerable subjects to enroll in studies, fudge diagnoses to recruit otherwise ineligible subjects and keep subjects in studies even when they are doing poorly.
Tech Rivalries Impede Digital Medical Record Sharing
by Robert Pear - NYT
WASHINGTON — Since President Obama took office, the federal government has poured more than $29 billion into health information technology and told doctors and hospitals to use electronic medical records or face financial penalties.
But some tech companies, hospitals and laboratories are intentionally blocking the electronic exchange of health information because they fear that they will lose business if they share information on patients with competing providers, administration officials said. In addition, officials said, some sellers of health information technology try to “lock in” customers by making it difficult for them to switch to competing vendors.
“We have received many complaints of information blocking,” said Dr. Karen B. DeSalvo, the national coordinator for health information technology. “We are becoming increasingly concerned about these practices.”
The White House and Congress are looking for ways to ensure a freer flow of information.
Mr. Obama has made computerizing patients’ medical records a priority of his administration. Four weeks after taking office, he signed an economic stimulus bill that offered bonus payments to doctors and hospitals adopting the new technology. He said that it would save money by reducing waste and duplication, and that it could save lives by improving care.
Many doctors and hospitals have begun using electronic medical records, but providers with different systems are often unable to share data in electronic form.
“We have electronic records at our clinic, but the hospital, which I can see from my window, has a separate system from a different vendor,” said Dr. Reid B. Blackwelder of Kingsport, Tenn., chairman of the American Academy of Family Physicians. “The two don’t communicate. When I admit patients to the hospital, I have to print out my notes and send a copy to the hospital so they can be incorporated into the hospital’s electronic records.”
Dr. Peter E. Masucci, a pediatrician in Everett, Mass., said he had been trying for more than five years to connect his electronic medical records with those of a hospital where he often sends patients. “It’s never happened,” he said.
In a report to Congress, Dr. DeSalvo gave several other examples:
by Robert Pear - NYT
WASHINGTON — Since President Obama took office, the federal government has poured more than $29 billion into health information technology and told doctors and hospitals to use electronic medical records or face financial penalties.
But some tech companies, hospitals and laboratories are intentionally blocking the electronic exchange of health information because they fear that they will lose business if they share information on patients with competing providers, administration officials said. In addition, officials said, some sellers of health information technology try to “lock in” customers by making it difficult for them to switch to competing vendors.
“We have received many complaints of information blocking,” said Dr. Karen B. DeSalvo, the national coordinator for health information technology. “We are becoming increasingly concerned about these practices.”
The White House and Congress are looking for ways to ensure a freer flow of information.
Mr. Obama has made computerizing patients’ medical records a priority of his administration. Four weeks after taking office, he signed an economic stimulus bill that offered bonus payments to doctors and hospitals adopting the new technology. He said that it would save money by reducing waste and duplication, and that it could save lives by improving care.
Many doctors and hospitals have begun using electronic medical records, but providers with different systems are often unable to share data in electronic form.
“We have electronic records at our clinic, but the hospital, which I can see from my window, has a separate system from a different vendor,” said Dr. Reid B. Blackwelder of Kingsport, Tenn., chairman of the American Academy of Family Physicians. “The two don’t communicate. When I admit patients to the hospital, I have to print out my notes and send a copy to the hospital so they can be incorporated into the hospital’s electronic records.”
Dr. Peter E. Masucci, a pediatrician in Everett, Mass., said he had been trying for more than five years to connect his electronic medical records with those of a hospital where he often sends patients. “It’s never happened,” he said.
In a report to Congress, Dr. DeSalvo gave several other examples:
We Need More Nurses
by Alexandra Robbins
SEVERAL emergency-room nurses were crying in frustration after their shift ended at a large metropolitan hospital when Molly, who was new to the hospital, walked in. The nurses were scared because their department was so understaffed that they believed their patients — and their nursing licenses — were in danger, and because they knew that when tensions ran high and nurses were spread thin, patients could snap and turn violent.
The nurses were regularly assigned seven to nine patients at a time, when the safe maximum is generally considered four (and just two for patients bound for the intensive-care unit). Molly — whom I followed for a year for a book about nursing, on the condition that I use a pseudonym for her — was assigned 20 patients with non-life-threatening conditions.
“The nurse-patient ratio is insane, the hallways are full of patients, most patients aren’t seen by the attending until they’re ready to leave, and the policies are really unsafe,” Molly told the group.
That’s just how the hospital does things, one nurse said, resigned.
Unfortunately, that’s how many hospitals operate. Inadequate staffing is a nationwide problem, and with the exception of California, not a single state sets a minimum standard for hospital-wide nurse-to-patient ratios.
Dozens of studies have found that the more patients assigned to a nurse, the higher the patients’ risk of death, infections, complications, falls, failure-to-rescue rates and readmission to the hospital — and the longer their hospital stay. According to one study, for every 100 surgical patients who die in hospitals where nurses are assigned four patients, 131 would die if they were assigned eight.
In pediatrics, adding even one extra surgical patient to a nurse’s ratio increases a child’s likelihood of readmission to the hospital by nearly 50 percent. The Center for Health Outcomes and Policy Research found that if every hospital improved its nurses’ working conditions to the levels of the top quarter of hospitals, more than 40,000 lives would be saved nationwide every year.
LifeFlight expanding operations in Bangor, adding jobs
By Evan Belanger, BDN Staff
Posted May 27, 2015, at 8:54 p.m.
BANGOR, Maine — LifeFlight of Maine has begun its move to expand operations in Bangor with the introduction of its first fixed-wing aircraft, which will free up the group’s two helicopters from certain duties and provide high-speed transport for the critically ill and injured.
Voting unanimously Wednesday, the Bangor City Council approved an agreement for LifeFlight to lease 17,000 square feet of hangar space and more than 7,000 square feet of office space in what is known as Hangar No. 600 at Bangor International Airport.
According to airport director Tony Caruso, the lease will expand LifeFlight’s presence at the airport as it moves from a single bay in another hangar near the Maine State Police office building.
The expansion is expected to bring additional jobs to Bangor. LifeFlight executive director Thomas Judge said the group will hire eight additional pilots and an additional aviation mechanics technician.
Over time, he said, it will bring in additional clinical providers and communications specialists. LifeFlight has 75 to 80 employees statewide.
Under the 10-year agreement, which includes a five-year renewal term, LifeFlight will make improvements to the facility, including the restrooms, heating and ventilation and Internet technology as well as adding stairs and fire suppression systems.
Declaring the improvements a “mutual benefit,” the lease allows LifeFlight credits for the improvements. City officials estimate LifeFlight will pay $75,000 per year for the first five years and $95,000 per year for the remaining years.
The expansion comes as LifeFlight prepares to begin offering fixed-wing operations May 18.
According to Judge, the twin-engine, fixed-wing aircraft to be based in Bangor can fly in more weather conditions and is about 115 mph faster than the helicopters.
It also can fly more efficiently over longer distances, freeing up helicopters for other missions.
Last year, LifeFlight transported more than 1,600 patients from different parts of the state to hospitals in and out of state. It was unable to assist about 500 others because its helicopters already were assisting others or weather prevented flight.
The total cost of the fixed-wing project is $3.5 million. Judge said the Camden Board of Selectmen voted last month to let LifeFlight use its municipal interest rate to borrow $2.25 million to purchase the turboprop plane.
The rest of the money will be raised by the nonprofit’s foundation, which is working to raise $6.5 million to add a third helicopter to the fleet.
Mercy Hospital to lay off 45, close Westbrook addiction center
By Darren Fishell and Jackie Farwell, BDN Staff
Posted May 27, 2015, at 4:26 p.m.
PORTLAND, Maine — Mercy Hospital announced Wednesday it will close its addiction recovery center in Westbrook and transfer services to its State Street location.
The move will affect about 250 patients and 90 employees at the Westbrook clinic, which provides Suboxone treatment and counseling for patients recovering from heroin, prescription painkiller and alcohol addiction.
While Mercy patients will continue to receive care, the hospital will stop accepting patients referred by other health practices throughout Maine for outpatient addiction treatment, said Scott Rusk, vice president and chief medical officer for Mercy. Health providers throughout the state, from Down East to north of Bangor, rely on Mercy for those referrals now.
“We really want to keep it open and be that statewide resource, we just can’t afford to subsidize that program anymore,” Rusk said.
Mercy plans to lay off 45 employees, while another 45 employees who staff the inpatient and day programs of the Westbrook addiction center will move to the State Street campus on July 1, Rusk said.
The Westbrook clinic, which offers Suboxone treatment for opiate addiction, will stay open through Aug. 31. Rusk said hospital officials in the meantime will work to find other ways for patients to fill prescriptions through primary care providers.
“We will be sure to find them a provider in the community over the next three months,” Rusk said.
About a third of the Westbrook clinic’s patients will remain with Mercy and get care under a new model, with teams of doctors and nurses treating their addiction as part of their overall health, Rusk said. The other two-thirds either have doctors outside the Mercy system or have no doctor and will receive help finding care and filling prescriptions, he said.
“We’re not going to abandon any of our patients from the clinic,” Rusk said.
The standalone addiction clinic is a small part of Mercy’s broader treatment program for substance abuse, which also includes detoxing patients admitted to the hospital, Rusk said.
Maine's Largest Substance Abuse Treatment Center Shutting Down
By SUSAN SHARON
WESTBROOK, Maine - The state's largest substance abuse treatment center will close its doors by the end of August, and attempt to find placements for about 250 patients who are being treated with Suboxone for their opiate addiction.
Officials with Mercy Recovery Center say the decision, made public late this afternoon, is the result of decreasing insurance coverage and declining Medicaid reimbursement rates.
The announcement comes at a time when deaths from heroin and other opiates are at an all-time high, and when the LePage administration is proposing to eliminate MaineCare coverage for methadone. Methadone and Suboxone are considered the best medication options for treating opiate addiction.
"We are doing a programmatic change in that we're not going to have a dedicated addiction clinic. We are changing the scope and scale of addiction programs for the community that we serve," says Dr. Scott Rusk.
Rusk is the vice president and chief medical officer for Mercy Hospital, which runs the Mercy Recovery Center in Westbrook. Rusk says an in-patient treatment program will be moved from Westbrook to Portland, along with several group therapy programs.
But as of Aug. 30, the free-standing addiction medicine clinic will be gone. Rusk says that affects about 90 staff members, about half of whom he hopes can be reassigned. It also affects about 250 Suboxone patients.
"It's very sad and I can't tell you how upset everybody is," Rusk says. "We've been struggling for many years with trying to maintain a sustainable program up there, but at this point we are seeing accelerated reimbursement loss for everybody, such that we've been in the red for so long that we can no longer support subsidizing the program."
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