By Jane Sarasohn-Kahn. Electronic health records (EHRs) broaden access to patient data and provide the platform for pushing evidence-based decision support to clinicians at the point-of-care. This promotes optimal care for patients, reduces medical errors, optimizes the use of labor, reduces duplication of tests, and by the way, improves patient outcomes. When done in aggregate across all health providers, a team from McKinsey estimates that $40 billion of costs could be saved in the U.S. health system.

Reforming hospitals with IT investment in the McKinsey Quarterly talks about the American Reinvestment and Recovery Act’s (ARRA) $20+ billion worth of stimulus funding under the HITECH Act and estimates that 80% of existing hospital IT applications will be affected by the regulation. Hospitals will be spending about $120 billion to meet the adoption and meaningful use provisions of the Act. This equates to $80,000 to $100,000 per hospital bed. ARRA incentive payments will cover roughly 20% of this cash outlay, meaning that $60-80K won’t to covered.

But McKinsey says, “Hold on!” There are ways to recoup the spending gap between HITECH incentives and cash-out-of-the-hospitals-budget. McKinsey’s research calculates that optimizing labor, reducing adverse drug events and duplicate tests, and adopting revenue cycle management can help the average hospital save $25,000 to $44,000 per bed each year. That gets to the $40 billion in annual savings when multiplied across all hospital beds in the U.S.

In operational terms, the savings accrue through:

• Managing inpatient beds more efficiently using equipment-scheduling software
• Optimizing the use of clinical equipment
• Determining optimal staffing
• Reducing administrative waste
• Reducing adverse drug reactions through computerized-physician-order-entry (CPOE) which cost $8,000 to $15,000 per bed each year (up to $3 million for a 200 bed hospital)
• Managing the revenue cycle by billing unbilled services, equivalent to 0.4% of hospital services, or $4,000 per bed.

Jane’s Hot Points: The McKinsey team rightly points to three critical success factors for maximzing health IT investments that the most wired, effective hospital-adopters have learned: get critical buy-in among clinicians and hospital execs early in the HIT adoption process; ‘radically’ simplify health IT architecture; and, elegantly plan and execute.

It’s the implementation phase in health IT adoption that so often gets short-shrift. McKinsey notes that Canada’s hospital system devoted 30% of its entire budget to change management. That’s a big number, but it’s also where rubber meets road: a capital outlay of $N million is the easy part of HIT adoption. The follow-on implementation resources, both in terms of sheer dollar volume and labor/staffing, along with disruption of clinical workflow, is the hard part. But getting to meaningful use will require no small amount of implementation effort in the form of evangelism, education and training, and ongoing assistance and support.

Originally posted on The Health Care Blog on August 18th.

Debates continue about the impact of health reform on small businesses. Mine is a small business so I’ve been paying close attention. I’ve even read every line of this legislation – three times. And every pundit analysis I can get my hands on.

My role as a strategist requires that I understand the law. My role as a business owner requires that as well. Most analyses make broad-brush statements and it’s not possible to know the full impact until each business does its own analysis. Here’s mine.

Unfortunately, there are no ‘upsides’ for my employees or business:

• My company is too small to be required to provide health insurance. That’s of no matter, I’ve been providing it all along.
• My company is unlikely to grow to the size required to provide health insurance. That’s of no matter, I’d do it anyway. As an employer I know the value of a healthy workforce.
• My company is too busy to even consider applying for grant funds for worksite health promotion and disease prevention. We’d lose productive work hours watching for RFPs, framing proposals and even more complying with paperwork. That’s of no matter, I’ve been providing that all along as well.
• My company is composed of workers too highly compensated to qualify for insurance tax credits, and I suspect no company like mine will qualify either. My employees are knowledge workers with advanced degrees and compensation above the $50,000 annual ceiling for the tax credit provisions.

Unfortunately  there are ‘downsides’ for my business, all related to new IRS rules.

Section 9006 mandates that about 18 months from now, my business – which really means my Executive Assistant, who is already plenty overloaded – will be required to issue 1099 tax forms to any individual or company from which we buy more than $600 in goods and services.   

We already issue an IRS Form 1099 to people like freelancers who are not ‘incorporated’ business entities. In any given year, that number ranges from 10-14.

That means we don’t send a 1099 to other incorporated businesses, that is, to Amazon, Amtrak, US Airways, Continental Airways, British Airways, Air France, Westin Hotels, Marriott Hotels, Holiday Inns, Kinko’s, Federal Express, Staples, Office Supply, Office Doctor, IT Edge, Samsung, Independence Blue Cross…I could go on.  

This new 1099 reporting is intended to capture currently unreported income to generate more government revenue and help offset the cost of reform. It’s been defended as an alternative to raising taxes on small business and is seen to be a fair trade for $35 billion in tax credits small businesses get under reform. It’s an attempt to collect the nearly $300 billion of income that the IRS says goes unreported.

I have three problems with that:

• First, my business won’t see any of that tax credit benefit, 
• Second, my business will incur additional costs, not only in staff time for obtaining tax IDs from every vendor, but also in accountant fees for processing and mailing the forms, and
• Third, my business is being required to help the IRS monitor tax reporting compliance of other businesses.

At this point, we estimate the number of 1099s we will file will increase to 1,000. I’m not sure how a small firm like mine is going to find its way through the mazes of large companies to get the information, but I’m angry that this law – touted as having so many ‘upsides’ – provides none for my firm but asks us to carry an additional burden that drives up the cost of doing business.

I can live without the ‘upsides.’ I’ve provided insurance and promoted wellness all along and will continue to do so.

But now, I’ve been mandated to become a de facto agent of IRS enforcement. Surely, the IRS has better tools for finding unreported income than asking small firms like mine to do it for them.

By Pamela Cipriano. On July 13, 2010, the clock started running for eligible providers, hospitals, and critical access hospitals, to become meaningful users of certified electronic health records (EHR). Under the direction of the Secretary of Health and Human Services, the Centers for Medicare and Medicaid, together with the Office of the National Coordinator for Health Information Technology (ONC) released the final rules that lay out the first two years of requirements for eligible professionals to qualify for incentive payments included in provisions of the American Recovery and Reinvestment Act of 2009 through the HITECH act (Health Information Technology for Economic and Clinical Health).  View the press conference led by Secretary Sebelius.   (Disruptive Woman Regina Holliday, spoke at the press conference)

Seven months and 2000+ professional and public comments later, the final rules lay out a three phase graduated approach of requirements for demonstrating meaningful use of certified EHRs.  Since not one stakeholder group is wholly enamored with the rules, they are more than likely equitable and balanced.  Listening to the feedback, the ONC made a number of changes from the proposed to the final rules, taking into account concerns about the speed and scope of implementation of criteria to qualify as a meaningful user.  Groups across the industry gave faint praise as they acknowledged the greater flexibility in the final rules and an easing of some of the requirements.  The phased approach lays out the goal for Stage 1 as capture of data in coded format, Stage 2 exchange of information with emphasis on guiding and supporting care processes and coordination, and Stage 3 improving outcomes by focusing on decision support with improved access to comprehensive patient data.

With quality at stake, the meaningful use incentives tie payments to achieving advances in health care processes and outcomes.  The payments are intended to help accelerate use of HIT. Fortunately there is already broad agreement that populating data into EHRs, using electronic prescribing, reviewing and sharing data across providers and settings, and reporting on quality measures has a positive effect on care.  Dr. Don Berwick, newly appointed Administrator of the Centers for Medicare and Medicaid, emphasized that the new rules define the use of EHRs that is “meaningful to care and to people,” emphasizing the direct improvement in patient safety, transparency, and access to data resulting in better, safer, and more reliable care for everyone.  Certified EHRs help providers know more about their patients, make better informed decisions, and reduce costs of care.  Electronic systems can reduce potential for errors, and enable consumers to work with their providers to coordinate and manage their care.     (more…)

By Robin Strongin. When the Obama Administration announced the new regulations expanding preventive care, ensuring that essential screenings and tests would be covered without co-pays for deductibles, my first thought was that this may be one of the most important provisions of health reform in terms of improving the overall health and well-being of the American people.

My second thought concerned forests, falling trees and sounds we may or may not hear.

The history of health care in the United States is, in large part, defined by sound policies and vital programs that are not accompanied by effective outreach to  the patients and consumers who have the most to gain from these innovations.  Thus, new provisions expanding preventive coverage have the potential to be like the proverbial tree falling in an empty forest.  If we don’t do a good job letting people know these services are more accessible, will they take advantage of them?

I think of the millions of people who are eligible for Medicaid or for Children’s Health Insurance Programs who aren’t enrolled.

I think of the widespread confusion that existed in the early days of the Medicare Part D prescription drug program until several organizations stepped in to conduct coast-to-coast information sessions with seniors.

And I think of the story that just appeared in the New York Times (http://www.nytimes.com/2010/07/15/health/15chen.html?_r=2&ref=health&pagewanted=print) regarding the growth in usage of the “medical home” model for health care.  (I prefer the term health home, but that’s for another post.) As Dr. Pauine Chen pointed out in the Times, empirical evidence is showing that the medical/health home – shorthand for greater care coordination between the patient’s primary care physician, specialists and other health care professionals – is working.  A demonstration project sponsored by the American Academy of Family Physicians showed that the new model was improving quality of care, efficiency of operations and physicians’ job satisfaction.

But patients hated it, because no one bothered explaining to them why their one-on-one relationship with their health provider was being replaced by a one-in-three or one-in-four relationship with multiple providers, even if it resulted in better care.

And, thus, does this new innovation in health care delivery fall within the proud history of U.S. health care in which great ideas are not linked with communication to the patient.

As health reform is implemented, both the public and private sectors need to do better, beginning with outreach to let people know about the new preventive care coverage and, more importantly, to ensure that Medicaid expansion and the new subsidies to help make private health insurance more affordable affect the people for whom they are intended.

By Glenna Crooks. On Sunday July 4, HealthDay News reported on a June 30 Environmental Health Perspectives item that the health benefits of cycling in an urban environment outweigh the risks. Huh? I asked myself.

I live in Center City Philadelphia and far too many cyclists – I’ll go out on a limb and say a majority – are a menace. They ride on pedestrian walkways, sometimes IPod hearing-impaired, weaving through pedestrians. They ride on the wrong side of the roads, the wrong way down one-way streets and weave between traffic lanes. They do not stop for red lights. In fact, some bikes don’t have brakes.

I’ve been nearly hit twice by cyclists running red lights, coming from between trucks and therefore not visible to a pedestrian until they appear suddenly, inches away. And, at 6:10 AM several months ago, while taking a work-out jog on a paved path along the Schuylkill River with my trainer Morris (March Man of the Month), was rammed from behind by a cyclist. Though it was clearly past dawn, he did not see me, perhaps because his head was down to lower the drag created by an upright body, going fast on a path that is frequented by walkers of all ages.

The accident has cost me nearly $500 a month in out-of-pocket expenses since, to address the back pain it caused. I’m lucky, though. Around that same time two pedestrians were killed in my neighborhood by cyclists.

I had visions – no, nightmares – of public policymakers seeing this report and encouraging more cycling in the US. Who on earth would believe that cycling was safe, I wondered? How could I change their minds? I had to read beyond the first sentence to understand. (more…)

By Robin Strongin. Republicans on Capitol Hill are still steaming over President Obama’s decision to install Dr. Donald Berwick as administrator of the Centers for Medicare and Medicaid Services via a recess appointment (http://www.politico.com/news/stories/0710/39759.html), bypassing the normal confirmation process which would have included a hearing before the Senate Finance Committee.

Now, GOP members of the Finance Committee are insisting, in a letter to committee chairman Max Baucus (D-MT), that a hearing should take place anyway.  In their letter, they argue that the lack of such a forum “casts a shadow over (Berwick’s) legitimacy and authority to serve as administrator during a critical time for CMS.”

That rhetoric may be overhyped.  After all, Berwick is hardly the first nominee, Democratic or Republican, to take office by virtue of a recess appointment.

Nonetheless, there is a legitimate point here that a hearing needs to take place.  But, while Senate Republicans want to grill Berwick on his now-infamous speech that some interpret as extolling the virtues of Britain’s National Health Service, I believe there is a far more compelling reason for him to face congressional inquisitors.

By 2014, approximately 30 million now-uninsured Americans are going to be joining the ranks of those with health coverage and, in so doing, significantly increasing the utilization of health services.  As many analysts have pointed out, if this utilization escalation happens within our current health care system, it’s reasonable to expect health costs to shoot skyward without a commensurate increase in quality and cost-effectiveness. (more…)

By Mary Grealy.  An organization of health industry chief executives today applauded federal regulators for being responsive to the concerns of hospitals and physicians in constructing the final “meaningful use” regulations that will determine the allocation of health information technology (HIT) incentive funds.  But, said the president of the Healthcare Leadership Council (HLC), the newly-released rules leave some critical issues still unaddressed.

HLC president Mary R. Grealy said that, even though her organization was still analyzing the regulations, “it’s clear that federal regulators paid close attention to the more than 2,000 comments they received on the proposed rule, and that they have been responsive to concerns that the initial regulations placed the “meaningful use” bar so unrealistically high that the health technology revolution would have been slowed instead of accelerated.”

The “meaningful use” regulations establish standards that health providers must meet in order to qualify for a share of the more than $27 billion authorized by Congress in last year’s economic stimulus legislation.

The Healthcare Leadership Council is a coalition of chief executives from all sectors of American healthcare.

Ms. Grealy said, “An example of this responsiveness is seen in the fact that the rules no longer require that, in the initial stage of implementation, all of a health provider’s administrative transactions must be included in an electronic health record.  That simply wasn’t realistic.  Those requirements are now in Phase 2 of implementation, which is achievable.”

She said, though, that legitimate concerns remain.  For example, the regulations should consider each campus of a multi-campus hospital system as a separate entity in qualifying for HIT incentive payments.  And, she said, health providers who have built and succeeded with their own information technology systems should be grandfathered into the universe of successful “meaningful use” qualifiers, but that doesn’t appear to be the case based on an initial review of the rules released today.

Nonetheless, Ms. Grealy said, “we’re seeing important progress with these regulations.  Clearly, the administration saw there was a gap between the theoretical standards they initially wanted to apply and the real-world challenges that physicians and hospitals face in achieving HIT advancement.   We all want the benefits that come from information technology – enhanced patient safety, more cost-efficient operations, greater use of evidence-based medicine – but to make strides forward, regulators and providers need to be moving at a coordinated pace.”

Orignially posted on Prognosis: A Healthcare Blog on July 13th

Disruptive Woman Regina Holliday’s testimony at the release of the final rules on meaningful use on Tuesday.

Straight from AHRQ….

This week HHS announced final rules to help improve Americans’ health, increase safety and reduce health care costs through expanded use of electronic health records (EHR).  The announcement marks the completion of multiple steps laying the groundwork for the incentive payments program.  One of the two regulations announced today defines the “meaningful use” objectives that providers must meet to qualify for the bonus payments, and the other regulation identifies the technical capabilities required for certified EHR technology. Select to access the announcement.

By Robin Strongin.  This evening I will be moderating a panel of three Washington Post reporters: Ceci Connolly, Amy Goldstein and David Brown.  They will be discussing LANDMARK, the book they, and other Washington Post reporters wrote about the new health care law, the Patient Protection and Affordable Care Act.

The first book on the Obama Administration’s ground-breaking piece of legislation, the Washington Post’s guide to health-care reform traces the rocky path Obama and the Democrats traveled to achieve this historic overhaul, explains the legislation itself, and shows how it will impact America.

We will be summarizing the presentations and posting about it tomorrow.  In the meantime, if you have any questions you would like me to ask one of the reporters, send them my way.

LANDMARK’s riveting behind-the-scenes narrative, reported by Ceci Connolly, reveals just how close President Obama’s signature initiative came to defeat, as well as the compromises and deals that Obama and his Democratic majority in Congress made in achieving what has eluded predecessors for 75 years: a law that expands and transforms America’s health-care system. In the second section, a Washington Post reporting team led by Alec MacGillis answers some of the most pressing questions about the health-care law’s immediate and long-term impact. The book also includes an accessible summary of the legislation itself, produced by the Congressional Research Service of the Library of Congress.

By Robin Strongin. No such thing as a summer vacation for those Inside the Beltway tasked with implementing and explaining health reform.

In case you were looking for some summer-time reading, the new insurance portal, http://www.healthcare.gov/ just launched (a few hours ahead of its July 1 deadline).  You can work your way through 500 pages of content and state-by-state listings of more than 5,500 open health insurance products.

And if that’s not enough to quench your health reform thirst, The new National Prevention, Health Promotion and Public Health Council, created by the Affordable Care Act, submitted its first status report to Congress on July 1.

Chaired by Surgeon General Regina Benjamin and composed of senior government officials across federal departments and agencies, the Council is charged with elevating and coordinating prevention activities and designing a focused strategy across federal departments to prevent disease and promote the nation’s health. The report submitted is the Council’s first, and an early step in the Administration’s development of a first-ever National Prevention and Health Promotion strategy. The Strategy’s impact will be significant because it will take a community health approach to prevention and well-being—identifying and prioritizing actions across government and between the public and private sectors. Both the forthcoming Strategy and the ongoing work of the new Council present a historic opportunity to bring prevention and wellness to the forefront of the nation’s efforts to improve the health status of all Americans.

Read the Council’s report.

Read the Fact Sheet.

By Joy Burwell

You’re Invited to

“Solutions To Scale: Proven Health Care Models for Primetime”

 Wednesday, June 30, 2010

 9:00 – 11:30 am

Breakfast will be served at 8:30 am

Kaiser Family Foundation

Barbara Jordan Conference Center

1330 G Street, NW

Washington, DC 20004

 Raise the Voice, a program of the American Academy of Nursing supported by a grant from the Robert Wood Johnson Foundation, showcases the work of “Edge Runners” – nurse researchers and experts who have developed proven care models and interventions that demonstrate significantly improved clinical outcomes and cost savings.  The Edge Runners will share their experiences to highlight what does and does not work for consideration by federal and state agencies during health care implementation.

Welcome:

• Diana J. Mason, PhD, RN, FAAN, Editor-in-Chief Emeritus, American Journal of Nursing
• The Honorable Robert Borski

Opening Remarks:

• Ken Thorpe, PhD, Department of Health Policy and Management, Rollins School of Public Health, Emory University

Panel One:

• Tina Johnson, CNM, MS, Practicing Nurse Midwife
• Tine Hansen-Turton, MGA, JD, CEO, National Nursing Centers Consortium, Executive Director, Convenient Care Association, Raise the Voice Edge Runner
• Eileen M. Sullivan-Marx, PhD, CRNP, FAAN, Advisor, Living Independently For Elders (LIFE), Raise the Voice Edge Runner
• Deirdre Baggot, BSN, MBA, Administrator for Cardiac and Vascular Services, Exempla Saint Joseph Hospital, CMS ACE Demonstration Site for Bundling Payments
• Sandra Haldane, BSN, MS, RN, Chief Nurse, Indian Health Service

Panel Two:

• Randall Krakauer, MD, FACP, FACR, Head of Medicare Medical Management, Aetna
• Susan Reinhard, PhD, RN, FAAN, Senior Vice President, AARP Public Policy Institute, Chief Strategist, Center to Champion Nursing In America
• Matt Salo, Director Health and Human Services Committee, National Governors Association

Moderator:

• Scott Hensley, National Public Radio

RSVP: Joy Burwell 202-263-2971 or jburwell@amplifypublicaffairs.net

Sponsored by the American Academy of Nursing’s Raise the Voice Campaign. Raise the Voice is supported by a grant from the Robert Wood Johnson Foundation

By Lynn Shapiro Snyder. Reproduced with permission from BNA’s Health Care Policy Report, 18 HCPR 680 (May 3, 2010). Copyright 2010 by The Bureau of National Affairs, Inc. (800-372-1033) http://www.bna.com

Health reform is a process, not an outcome. The health care industry needs to treat Phase II of health reform—–implementation by the Executive Branch—with the same focus and zeal as they did with Phase I—deliberation and passage by the Legislative Branch. It may not be as sexy as Capitol Hill but industry participation in shaping implementation through the Executive Branch could have an even greater impact for industry efforts. Phase II is when the rubber of ‘‘the law’’ meets the road of ‘‘the real world.’’ We are one month into implementation so now is the time for the health care industry to step up to the plate and continue to shape the details of federal health reform currently being developed and implemented by the Executive Branch.

As with any topic of public policy, proposed laws are discussed in Congress. Final laws are sent to the Executive Branch for interpretation and rulemaking within something called ‘‘congressional intent.’’ Public comments hopefully are considered by the relevant agencies writing the regulations. Challenges to the regulatory process may occur when the regulations go too far from the words and intent of the statute. Eventually, issues may be sent back to Congress to amend the law. The federal Medicare program has worked this way for over 43 years.

However, in the implementation of federal health reform, we are seeing new creative elements to the implementation process. The Obama administration is asking industry to take steps that are not in the statute. For example, on April 19 Department of Health and Human Services Secretary Kathleen Sebelius sent letters to health insurance companies asking them to continue to cover young adults so that they can remain on their parents’ policies notwithstanding the terms of the policies (18 HCPR 604, 4/26/10). This health reform provision does not take effect until Sept. 23, 2010. She was seeking
collaboration with industry on a topic that could make sense for all involved.

Sebelius also recently sent a letter to the health insurance industry trade group, America’s Health Insurance Plans, challenging the group’s interpretation of a section of the statute related to the coverage for children with pre-existing health conditions even before any regulations were published (18 HCPR 469, 4/5/10). The statute appears to nullify pre-existing illness exclusion contractual provisions for enrolled children later this year but there was a question whether guaranteed issue of health insurance for these and other children had to wait until after 2013. Nevertheless, the administration obtained a promise from private health insurers for guaranteed issue this year for this particular population notwithstanding what some believe are the words in the statute.

Successful implementation of the 2000+ pages of the federal health reform law requires collaboration between the Executive Branch and the health care industry stakeholders. This is because the law is based upon actions to be taken by key health care industry stakeholders, such as health insurers to increase access, and health care providers to achieve Medicare savings.

And since we never had a federal department of health insurance before this new law—health insurance had been regulated mostly at the state level—the Executive Branch’s need for continuous public input and collaboration with industry is even more compelling. The same is true for some of the creative new pilot programs designed to customize the Medicare payments for certain providers.

A big part of implementation is in the Executive Branch’s federal rulemaking activities. That is when the public has the formal opportunity to collaborate with the administration on federal health reform. Not all provisions in the recently enacted Patient Protection and Affordable Care Act (Pub. L. No. 111-148) and its companion, the Health Care and Education Reconciliation Act (Pub. L. No. 111-152), require a federal regulation. Some provisions are self-executing while others specifically require a designated federal official to publish regulations on a particular topic. For other provisions, it depends.

(more…)

By Glenna Crooks. Full disclosure – I’ve practiced yoga fairly consistently for decades. It’s been good for me.

In grad school it helped me stay focused – and calmer – through killer statistics classes. Later, it was a way to unwind at the end of a workday. Still later, it saved me from surgery to correct fairly severe scoliosis. It’s not cured the deformity but I’m virtually pain free most of the time – no small feat for one who spends 18-24 hours on flights and 8 hours standing to facilitate meetings.

More disclosure – I am certified to teach, though I don’t. The same erratic travel schedule that prevents attending classes on a regular basis precludes committing to teaching them. I trained to be able to practice on the road. It was a good investment of my time and funds.

Yes, my time and funds. Anyone familiar with yoga knows that for the most part, students pay a small amount for a class – or series of classes – out of their own pockets. Sometimes, yoga is offered in schools, hospitals, churches, workplaces and prisons and the cost partially or fully paid by some third party. Sometimes teachers donate their services as part of the ‘selfless service’ that embodies the lifestyle.

Recent weeks presented an interesting confluence of events in my life as a yoga-practicing health policy analyst: health reform passed and Yoga Journal published a major article on methods, issues, controversies and implications of yoga research.

I started a yoga research literature review a few years ago. It was to be the opening chapter of an adaptation of my grantseeking guide (see www.strategichealthpolicy.com for a free download), revised and updated for yoga teachers intending to seek and secure third-party – including health insurance – financing support for classes.

I abandoned the project for many of the issues raised in the Yoga Journal article: research methods were relatively undeveloped, uncontestable positive results were scant and within the yoga community both were controversial. That’s right, even the need for research to demonstrate the value of yoga is controversial. Many thought there was proof enough.

Proof enough for an individual to pay? Yes, that’s been well-demonstrated. Thousands of times each day, people around the world pay out-of-pocket to attend classes. Proof enough for a third-party to pay? Far from it, at least as we have defined proof within the American health care sector.

Now, the health reform era is upon us, some people will press for yoga services as a covered benefit and if a serious discussion takes hold – and succeeds – in adding yoga to American health care armamentarium, yoga teachers will face issues common to other product and service providers. Clearly, not all yoga teachers will want to participate and none will be forced, but those who choose to do so will need to address – at a bare minimum – questions commonplace to physicians, hospitals and drug companies:

First, is yoga effective? Any prevention or treatment modality used in health care is expected to be safe and effective, demonstrating that it performs as advertised, promoted and hoped.

That means prospective research, such as trials comparing yoga against a non-intervention, a placebo or a standard therapy treatment, or a study of a sufficiently large population through ‘natural observation’ to gather similar evidence over many years.

Research such as this will raise questions about whether the ‘style’ of yoga matters, how many sessions might be required to achieve results and whether results last after classes are stopped. People in the study will be carefully selected and ‘assigned’ to each intervention group. They’ll be asked about other aspects of their lifestyle to assure that they’re not confounding the results with other possibly-effective therapies.

Side effects will be monitored. Injuries in class or suicidal thoughts outside of class (if any occur) will be noted so that cautionary warnings and contraindications can be addressed in coverage and reimbursement decisions. Other unintended consequences – weight loss comes to mind – will be documented but can’t be claimed a benefit unless the study was specifically designed to test for it.

Research might also need to tease out yoga’s “mechanism of action” as is the case for medications; for example, by what mechanism does yoga breathing techniques reduce hypertension?

Researchers will be required to seek approval from Institutional Review Boards protecting patients, may be required to vet research methods with regulators or payers, will likely be required to disclose financial interests in yoga and if any are found might be precluded from doing research and/or might be restricted from committees that address yoga policy and financing issues – all to assure research subjects are protected and conflicts-of-interest are prevented. (more…)

By Pamela Cipriano. Access to care from Nurse Practitioners got two boosts in recent weeks.  The health insurance reform legislation (Patient Protection and Affordable Care Act, Public Law 111-148) contains important provisions that will address payment and recognition of NP services in medical homes and nurse managed health centers. (Refer to Lisa Korin’s blog 4/16 on “The Patient Centered Medical Home Model:  A Way to CostiEffectively Improve Quality of Care”) Original plans for medical home models had been stalled, and included payment only for physicians; the new law recognizes nurse practitioners as leaders of primary care practices and makes them eligible for reimbursement.  Nurse practitioners are also key providers and leaders of Nurse Managed Health Centers (NMHC).  Reform legislation has made available a new $50 million grant program to help innovative safety net providers.  NMHCs provide a full spectrum of primary care including health promotion and disease prevention to under-served populations, primarily in areas where the supply of primary care physicians is not adequate.

Another development, which may be below most people’s radar screens is a timely report from the Macy Foundation.  Dr. Linda Cronenwett, Professor and Dean Emeritus of the School of Nursing, University of North Carolina, Chapel Hill, and Dr. Victor J. Dzau, James B. Duke Professor of Medicine, Chancellor of Health Affairs of Duke University, and CEO of Duke Health System were co-chairs of a conference held in January of this year addressing, “Who will provide primary care, and how will they be trained?” While hailing some of the newest developments in team care and use of electronic technologies, the group called for fundamental changes in the education of primary care providers as well as reformed payment structures and incentives that encourage more providers to engage in primary care to meet health needs of individuals and communities. The conference conclusions are rich in actions to address a future workforce, new interprofessional education models, strong innovative leadership, and removal of barriers that hinder nurse practitioners and physician’s assistants from being primary care providers.  A full report of conference proceedings is due out later this year; the co-chair conference summary can be found at:  http://www.josiahmacyfoundation.org/documents/jmf_ChairSumConf_Jan2010.pdf

A Yahoo! news report last week highlights all these developments, underscoring the debate around NPs providing primary care, but highlighting the patient satisfaction and quality outcomes we know are associated with care by NPs. http://news.yahoo.com/s/ap/20100414/ap_on_he_me/us_med_dr_nurse

UPDATE:

On our Facebook Fan Page, Susan Rinkus Farrell shared the following great video about Nurse Practitioners:

By Lisa Korin. The media has given much attention to the health insurance aspects of health reform, but less to aspects of the law addressing the root issues.  Yes, the number of uninsured is a huge problem, but let’s not forget that an increasingly chronically ill population needing access to often expensive health services is one the key drivers contributing to the plight of the uninsured even needing insurance.

According to the CDC, nearly 50% of the U.S. population suffers from a preventable chronic health condition, and these diseases account for 75% of the nation’s $2 trillion annual healthcare costs. Much of these costs arise from:  patients obtaining care from multiple healthcare providers, lack of medical care coordination, duplicate diagnostic testing and provider visits, and treatment non-compliance due to consumer confusion.  These facts indicate that increased spending on chronic conditions does not necessarily result in better health outcomes and means that patients with chronic conditions currently receive health care in a manner that may not be the most cost-effective.  These statistics are even more pronounced for minority adults and children as well as for those with low incomes, for whom there are greater disparities in access to care and treatment plan compliance.

That’s why I was glad to hear that H.R. 3590 Patient Protection and Affordable Care Act had provisions related to the patient centered medical home (PCMH) model of care.   According to the Patient Centered Primary Care Collaborative, PCMH is an approach to providing comprehensive primary care to adults, youth and children that broaden access to primary care while enhancing care coordination. Clinicians practicing in the highest level medical home will: (more…)