Thursday, August 26, 2010

Here We Go Again and Again and Again

Is it a rigid orthodoxy? Being stuck in closed information loop? Spending too much time with overweening loyalists? Portraying any opposition as the Devil Incarnate so much that you actually believe it?

These are the questions the Disease Management Care Blog ponders when otherwise smart bureaucrats recycle the same nostrums over and over.

Writing on the Kaiser Health News website, HHS Secretary Sebelius lauded the new momentum behind electronic health records. Thanks to the leadership in Washington D.C. she says, a breakthrough on industry-wide consensus on meaningful use has been achieved. As a result, the Disease Management Care Blog will be able to complete an clinic intake in Topeka and the information will be available in Toledo. If it gets bonked on the head in San Francisco, its old CAT scans will be available in Sanibel. Thanks to fistfuls of HIT dollars for doctors, Medicare, Aetna, United and Wellpoint can assure that the DMCB will get the same high quality care as Pastor Bloedow. Courtesy of Health Affairs, you can vicariously share in all that cheerleading here.

In the meantime, Ashish Jha, Catherine DesRoches, Peter Kralovec and Maulik Joshi have this Health Affairs web-first article on the recent uptake of electronic records in U.S. hospitals. Using survey data from the American Hospital Association, they investigated the progress made since passage of the American Recovery and Reinvestment Act. They found that less than 3% of hospitals are using fully functional electronic records and that the proportion using a more limited or "basic" record was less than 10%. Smaller and rural hospitals were the most likely to not have any system in place. What's more, a large majority of the hospitals that had made investments in electronic records do not meet the Fed's newly developed "meaningful use" criteria.

And then there is this New England Journal of Medicine article by Howard Koh and HHS Secretary Sebelius on "Promoting Prevention through the Affordable Care Act." They argue that the legislation will remove cost as a barrier to evidence-based preventive care, promote wellness in the workplace, boost community involvement, promote vaccine use, reinvigorate health promotion throughout the health system and attack the twin scourges of tobacco abuse and obesity.

If that sounds too good to be true, then maybe you've been reading too much DMCB. But don't take its word for it, here is an independent reality check appearing in this week's JAMA. If you can't access the full article by Neda Laiteerapong and Elbert Huang that's OK. While it has some positive features, the bottom line is that the ACA not only doesn't address the inability of primary care providers to manage the coming surge in demand and ignores the looming sustainable growth rate formula-driven cut in Medicare Part B physician payments. It also skips over the inconvenient truth that the prevention (and, by the way, treatment) of many conditions, "most notably, obesity" isn't really all that effective, especially over the short term.

The DMCB doesn't believe the Administration is intentionally spinning the ACA in sympathetic forums like KHN and the Journal that cater to entities most likely to benefit from the Federal healthcare ATM. Instead, it figures the folks at HHS are being unwittingly caught up by a perfect storm of cognitive dissonance, political sociopathy and overconfidence. It's looking forward to the time when the political class moves on and talks seriously about the next steps. More on these in a future post.

Coda: The California Department of Insurance has finally put the final approval on Anthem's scaled back but still double-digit rate increases. Since Federal-style health reform does little to handle costs, look for more of these types of premium increases being dumbed down to "reasonable."

And speaking of the Fed's ability to handle costs... a centerpiece of reform, the federally supported high risk insurance pools, have kicked off. Interestingly, one started in New Jersey on August 2 and so far, a total of two people have signed up. NPR says the premium levels have led to enrollment nationwide being lower than expected. Hat tip to the InsureBlog.

1 comment:

Michelle W said...

Thanks for listing that Health Affairs journal, I just read about it this morning over at The Wall Street Journal and posted a quick bit on how utterly common sense but important the findings are, specifically the great quote, "This [HITECH] is not a plug and play."

I remember reading a tech guy comment that plug-and-play used to more exactly mean plug-and-pray. When it comes to some of the claims coming out about health care now, I think we have a situation where people sincerely believe their actions are the best for the world and are acting on that belief.

But to make dreams come true you need more than a fairy godmother or a chorus of singing mice: you need to take a long hard look at reality and acknowledge when it doesn't reflect what you want it to. You have to admit when you might be wrong. You have to be honest about what problems might lie ahead. That's a problem facing all evangelists, policymakers included.