Welcome to Health Wonk Review June 26 Edition

Mmmmm! The Disease Management Care Blog invites you to feast at this blog cornucopia of wonkery. No need to line up at this buffet table – visitors have instant access to a broad array of yummy intellectually stimulating and educational morsels. For your sampling pleasure:

Information Technology

Julie Ferguson of Worker’s Comp Insider posts about I.T. behemoth Google’s foray into the electronic medical-personal-health record ether with a tasty, succinct and link-laden summary of the good (many are the benefits), the bad (physician inertia) and ugly (privacy breaches).

If it’s links and more links about Google Health you are looking for, Jessica Merritt of NursingDegree provides a delicious stew of them here. Everything you want to know and more is just a click away.

If we are going to get ugly over privacy, Neil Versel of Healthcare IT asks if his unsolicited free offer for an allergy medicine had anything to do with his past purchases of pseudoephedrine containing medicines. Is this recipe of name & address-list selling, data mining, meth-addict backlash and over-zealous disease managing a dysguesic brew?

Let’s get even uglier with the InsureBlog’s H.G. Stern’s review of Fed Chairman Ben Bernanke’s pessimistic economic assessment of health care. It costs a lot. It’s going to cost more. Information tech doesn’t hold a candle to growing demand paired with the bitter availability of ever pricier treatment options. And we are all going to pay for it. The DMCB’s food for thought is that the government is going to tax us into the poorhouse and then print up money to make up the difference. Now is the time to convert all assets into gold bullion and bury it in the back yard.

But let’s end this part of the buffet table with some good news from Vince Kuraitis over at e-CareManagement. Health care-consumer Goldilocks had three porridge PHI liquidity options, but the one that belongs to the ‘Markle Foundation’s Common Framework for Personal Health Information’ is not only the right temperature, it’s PHI ambrosia. Find out why here.

Health Insurance

Spin the channel through C-SPAN and it’s likely you’ll see Michigan’s Representative John Conyers in action. He and Democratic gadfly Rep. Kucinich have cooked up legislation named ‘The United States National Insurance Act.’ Sidle up to the left side of the buffet and have a plateful thanks to Louise at the Colorado Health Insurance Insider, who gives a thumbs up/thumbs down synopsis of each of the Act’s provisions. This is not only your chance to see what a national plan would look like up close and personal, but how supporters of the concept process their way through the various benefit and policy options.

And on the right, load up over at the We Stand Firm blog. Paul Hseih dissects the recent NYT report that Japan’s Ministry of Health is introducing mandatory waist circumference measurement and mandatory education for individuals not meeting criteria. While you ponder whether Toledo should be concerned about the threat of creeping government infringements in Tokyo, the DMCB wonders if a) ‘metabo’ is cool new word for those in the know and b) if the portly and recalcitrant Kenzo Nagata should be extended honorary U.S. citizenship.

Anthony Wright over at Health Access rails against another example of the individual market’s dyspeptic failure to exceed customer expectations by explicitly factoring in gender (care to guess if males pay more or less?) and a past history of a caesarian section in its health insurance pricing. Should we all contribute equally to the risk pool or should each pay according to the underlying risk? If you support the latter, be wary of the (un)intended pernicious undercurrent of gender discrimination. And don't blame the actuaries for any of your tone deafness either.

Wonder just how single payer advocates seem to get so much traction? Brian Schwartz of the Patient Power blog (‘because your health care is too important to be left to politicians’) dishes up a fascinating examination of how government taps into to mankind’s deep desire to be members of a group. By muddling our innate tribalism with government’s natural tendency to take over, says he, our cooperation over national health insurance is a symptom, not a solution. The DMCB wants to join the group that is opposed to this. Watch out, Uwe, someone has your number.

Jane Hiebert-White notified the DMCB of Chris Fleming’s Health Affairs blog link to a Health Affairs Web exclusive by Ku and Broaddus that argues that public health insurance programs like SCHP and Medicaid have the twin advantages of low cost and low out of pocket expenses. So, like, what’s there not to admire about public health insurance? Take a full helping of this open-access article and decide for yourself.

Or decide not to, based on this hot pepper multi-alarm capsaicined alert from the pseudonymed ‘Zagreus Ammon,’ a physician executive over at, you guessed it, the Physician Executive Blog. Heard of the 'National Provider Identifier Number?' If you’re a doc, forget about getting any money from CMS unless the NPI info, such as the spelling of your name with or without the middle initial, periods and blanks exactly matches the IRS legal name. If you’re not a doc, here’s another reason why the 9 words ‘I’m from the government and I’m here to help’ can be so terrifying.

Ku and Broaddus in the Health Affairs article mentioned above would probably agree with the perspective of Richard Eskow over at the Sentinel Effect Blog, who alerts us to the California Medical Association’s assessment of the market performance of California’s HMOs. Assuming there are some market forces at work somewhere, why are premiums going up and up and up? He smells something sour. Read his blog and see if you can help him and fans of unfettered health care markets make any sense of it. And by the way, think insurers fear regulations or mandates that limit their administrative expense ratio to 15%? Think again. Richard points out the easiest way to meet such a requirement is to simply raise premiums.

Bridging the Payer/Fiduciary-Provider/Clinician Divide

Tom Emswiler of New Health Dialog Blog updates us on CMS’ Premier Hospital Quality Incentive Demonstration (and teaches us about a new acronym: 'HQID'). Readers may recall this CMS initiative is aimed at rewarding hospitals that do well in 30 care measures while penalizing those hospitals that fail. The penalties are now being assessed, but fear not. The penalty amount this year does not seem too high and it’s a small price to pay for the average 16% overall improvement. CMS especially likes this dish!

David Harlow at the HealthBlawg updates readers on the no pay for errors movement, describing the major Massachusetts insurers’ announcement that they’re going to follow the Leapfrog Group’s recommendations. He also points out that according to Leapfrog, ‘never events’ should also be paired with an ‘always apologize’ policy. Harkening back to the innocent days of the Lettermen, the DMCB asks if quality means you never have to say you’re sorry?

Dr. Roy Poses over at Health Care Renewal serves up a major dose of disappointment over the outsourcing-run-amok craze, typified by the still unresolved and unexplained Baxter-Heparin tragedy. While the DMCB still believes in coordinated/networked delivery systems, Dr. Poses makes an excellent point on how health care is ultimately not about über management, it’s ultimately about taking responsibility for it and always doing the right thing.

Annie at the Revolution Redux Home of the Brave Blog bakes up an alternative point of view over the thorny issue of nurse-patient ratios. She pleads for the return of nursing control and authority, not legislating inflexibility and mandates.

David Williams of the Health Business Blog weighs in on another example of Aetna’s nimbleness, this time in the arena of medication compliance. The insurer has agreed to accommodate a University of Pennsylvania-led clinical trial that tests a financial award lottery to incent enrollees to take their warfarin. David is a fan of spicing up the insurance benefit to Get-Enrollees-To-Do-The-Right-Thing and, assuming the trial is positive, offers up some other interesting recipes.

The ever perspicacious Maggie Mahar at Health Beat discusses in Post 1 and Post 2 the sorry state of business-as-usual end-of-life cancer care and introduces the readers to the notion of ‘palliative’ oncology care. Using liberal sprinklings and dashes of anecdotes and peer-review literature, Maggie asks if we need – or rather, should expect - oncology expert-teams who can assess prognosis, incorporate patient preferences, institute hospice, offer reasonable treatments and communicate well with patients AND families. After all, such experts are in the best position to develop the best menu of services. Compared to the draconian options of limiting therapy, she argues the expert-palliative approach is far more acceptable. The DMCB also learned again about some viable outcome measures in oncology: assuming the right answers are not 0% and not 100%, just what is the ‘right’ percent of cancer patients that should be a) receiving (new or old) chemotherapy within X days of death, and b) in hospice within ‘Y’ days of death?

Before we leave this section of the table, take a Bromo-Seltzer and heed this warning from David Hamilton of BNET, who uses (and visually depicts) a food-making allegory to describe a brazen marketing business initiative aimed at empowering getting the chronically ill to empower themselves with buy drugs and devices. To get a good sense of where they’re coming from, check out Omnicom’s view of ‘medical professionals.’

Medical Education

Not necessarily a frequent topic in our wonk circle, but the on-going education and professional development of physicians is a huge industry that has been whipsawed its longstanding reliance on pharma funding. Barbara Martin at Pathophilia ladles up a lesson in grammar, writing and being reasonable for the Accreditation Council for Continuing Medical Education (ACCME) at this very spicy post. Click around and you’ll see the debate doesn’t end there.

There you go! Something for everyone. It's been my pleasure. And make sure you mark your calendar for the next Wonk Review. You can find out more about it here.