6 reasons today's heath IT systems don't integrate well

Although the healthcare community has been clamoring for integration of its IT systems for decades, the industry is still in a rather elementary stage when it comes to useful and practical systems integration, according to Shahid Shah, software analyst and author of the blog The Healthcare IT Guy.

"Our problem in the industry is not that engineers don’t know how to create the right technology solutions or that somehow we have a big governance problem," he said. "[Although] those are certainly issues in certain settings, the real cross-industry issue is much bigger – our approach to integration is decades old [and] opaque, and [it] rewards closed systems."

Shah outlines six reasons today's health IT systems don't integrate well.

1. They don’t support shared identities. These shared identities include single sign-on (SSO) and industry-neutral authentication and authorization, said Shah. "Most health IT systems create their own custom logins and identities for its users, including roles, permissions, access controls, etc., stored in an opaque part of their own proprietary database," he said, adding that ONC should mandate all future EHRs use "industry-neutral" and well-supported identity management technologies, so each system has, at least, the ability to share identities. "Without identity sharing and exchange, there can be no easy and secure application capabilities, no matter how good the formats are," he said.

2. They're too focused on "structured data integration." Instead, said Shah, systems should be focused on practical app integration in the early phases of a project. "In the early days of data collection and dissemination, it's not important to share structured data at detailed, machine-computable levels first, [but it's more] important that different applications have immediate access to portions of data they don't already manage." Once app integration is in good shape, he continued, then it's time to focus on structured data integration, and all the governance and analytics associated with it. "When we do structured data integration too early, we often waste time because we don't understand the use cases well enough, so we can't iterate to best-case solutions," he said. "We're driven to worst-case implementations."

[See also: 5 technologies every hospital should be using.]

3. They're more "push" data-focused versus "pull" data-focused. "A common question we ask at the beginning of every integration project is, 'What data can you send me?'" said Shah. "This is called the 'push' model, where the system that contains the data is responsible for sending to all those that are interested." Future EHRs need to implement syndicated ATOM-like feeds, which could contain HL7 or other formats, for all their data, so they can share and allow anyone who wants it to "subscribe" to the data, continued Shah.  In turn, this is known as the "pull" model, or when data holders simply allow secure, authenticated subscriptions to their data without worrying about direct coupling with other apps. "If our future EHRs became completely decoupled secure publishers and subscribers of the data, many of our integration problems would go away like they did for others using modern Internet approaches," said Shah. 

4. They're more focused on "heavyweight, industry-specific formats" instead of "lightweight, or micro formats." According to Shah, appointment scheduling in the "health IT ecosystem" is a major source of "health IT integration pain," he said. "If EHRs just used industry standard iCal/ICS publishing and subscribing, we could solve 80 percent of appointment schedule integration instantly." Shah continued and said to think about how an iPad can sync with an Outlook/Exchange server at work. "It's not magic – it's a basic, industry-neutral and appropriately securable standard, widely used and widely supported." Another example, he said, is the use of HL7 ADTs for patient profile exchanges, instead of more common and better-support standard like SAML. "If you've ever used your Google account/profile to log into another app on another website, you're using SAML," said Shah. "Again, no magic – it works millions of time a day with 'good enough' security and user-controlled privacy."

5. Data emitted are not tagged using semantic markup, so they're not shareable by default. "Even when we do have full data governance, we do our structured data integration and then we present information on the screen," said Shah. "We don't tag data with proper semantic markup, when it's basically free to do." Future EHRs, he continued, should generate Resource Description Framework-in-attributes (RDFa), using industry neutral schemas for common information, such as personal data. "Using RDFa as a start, EHRs can then start publishing full RDF in the future, so it's easier to discover where certain kinds of meta data can be found, without requiring massive registries and other old-style opaque techniques," he said. "None of this is technically challenging, insecure, or difficult to implement, if we really care about integration and are not just giving it lip service." 

[See also: 5 stages of EHR maturity and patient collaboration.]

6. They don't produce common output in a security- and integration-friendly way. Shah said future EHRs should start to use industry-neutral CSS frameworks, such as Twitter's Bootstrap, which is both free and open source. "When using Javascript, EHRs should use common, lightweight, and integration-friendly libraries, like jQuery, and not Javascript frameworks that take over the app and view port, and prevent easy discovery and integration." When you omit Javescript Object Notation (JSON) from your APIs, Shah continued, offer both JSON and JSONP, so secure integration can occur more easily. "All of these techniques … are commonly accepted, secure Web practices and need to make their way into our EHRs," he said. 

Telehealth pilot helps patients with kidney disease

PARIS – A remote telehealth pilot has shown promise for patients living with chronic kidney disease (CKD), yielding positive trial results in both patient satisfaction and patient support.

The pilot was also awarded the Innovation Prize this month in the telemedicine category at Hit Paris, France’s annual health IT tradeshow.

In a collaborative effort among Grenoble University Hospital, Calydial dialysis centers of France and AGDUC health center in France, patients living with CKD were selected to take part in a trial using remote patient monitoring technology provided by Canadian-based telecommunications provider, TELUS and Orange, the French communications company.

Patients in their homes were given e-tablets, connectivity and software to monitor their vital signs, manage their medication and treatment protocols and provide feedback to their care team. Early positive results have demonstrated the potential to replicate this solution across other institutions and for other chronically ill patients.

The pilot uses a network-centric, multi-function application that allows patients with conditions that require daily monitoring to coordinate with their healthcare providers from home. Patients and caregivers are able to access the application through a secure wireless network.

Kasra Moozar, vice president, TELUS Health Solutions explained that TELUS, has “ more than 10,000 patients using its remote patient monitoring technology to manage their chronic condition from the safety and comfort of their own home." Moozar said that the technology allows them to turn “information into better health outcomes for citizens."

"Telemedicine has the power to transform the way that healthcare is delivered, said Thierry Zylberberg, executive vice president, Orange Healthcare. “These telemedicine solutions can have a positive impact on care quality for chronic disease patients and care delivery for healthcare providers."

Need A Nurse? You May Have To Wait

Enlarge iStockphoto.com

Some fear that with rising medical costs and an aging population, the country's nursing staff will be stretched too thin.

iStockphoto.com

Some fear that with rising medical costs and an aging population, the country's nursing staff will be stretched too thin.

Nurses are the backbone of the hospital � just ask pretty much any doctor or patient. But a new poll conducted by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health finds 34 percent of patients hospitalized for at least one night in the past year said "nurses weren't available when needed or didn't respond quickly to requests for help."

Since nurses provide most of the patient care in hospitals, we were surprised at the findings. We wanted to find out more. We wanted to know what was going on from nurses themselves. So we put a call-out on Facebook.

We received hundreds of responses and read them all: piles of stories about nurses feeling overworked, getting no breaks, no lunches and barely enough time to go to the bathroom. Even worse, many nurses say breaks and lunchtimes are figured into their salaries and deducted, whether they take them or not.

 

When we asked nurses who responded to our call-out if we could interview them for broadcast, most said no. They worried about their employers' reaction. Many would be interviewed only anonymously.

"We're always afraid that something will happen to our patients during the time we're off the floor," one nurse says, "and I personally don't feel comfortable leaving them unless I know that a co-worker is actually looking after them during the time that I'm off the floor."

This nurse says she rarely stops. Not for 12 hours. She's an emergency room nurse in a busy urban hospital. The ideal, she says, would be one nurse for every three patients in her ER. But she typically cares for five patients or more � often eight, if she's covering for a colleague taking a lunch break. She says there are times when she can't leave patients' bedsides.

"Maybe I was injecting medication that you have to push slowly over five to 10 minutes so it doesn't harm them," she says, "and I can see the call bell going off in the hallway, and there's no way I could respond to that."

The only option is to literally yell down the hallway and hope another nurse hears her and responds to the patient call bell. There have been times when she has driven home at the end of her 12-hour shift, white-knuckling the steering wheel and wondering whether she "missed something."

Another nurse likens her job to "spinning plates," just "praying," she says, that one doesn't fall. "And these are human beings," she says, "not products on conveyor belts."

Stories like this suggest there's a shortage of nurses. But Linda Aiken, a researcher and professor of nursing at the University of Pennsylvania School of Nursing, says that's not the case. There was a shortage about a decade ago, she says. Today, that has changed. The number of RNs graduating has increased dramatically over the past decade, but many can't find jobs.

"There's not an actual nursing shortage," Aiken says. "There's a shortage of nursing care in hospitals and other health care facilities."

Nancy Foster, a vice president with the American Hospital Association, says hospitals are facing big financial challenges.

"In part, it's because our patients are sicker � coming to us with more intense diseases and disorders than they did 25 years ago," she says. "In part, it's because there's so many more medications and devices and other interventions at our fingertips; we can help many more patients and restore them to health."

That is terrific, of course, but it's not cheap. Any reduction in nurse staffing at a time of increasing patient demand jeopardizes patient care, Aiken says.

"Nurses are the surveillance system in hospitals for early detection and intervention [to save patients' lives]," she says.

According to one nurse, little clues from patients are critical.

"I mean, you might walk into a room, and they are breathing and answering your questions," the nurse says, "but if you look at their neck and the jugular vein is slightly distended ... taking the time to pick up on the small details like that are the early warning signs that somebody is getting sicker fast."

In our poll, 51 percent of those who were hospitalized overnight in the past year said they were "very" satisfied with their care. An additional 32 percent said they were "somewhat satisfied" � some things could have been better. Only 16 percent said they were dissatisfied.

It's not all bad news, but with a rapidly aging population, the fear is that the nursing staff will be stretched even more thinly. Plus, while our call-out to nurses on Facebook was not scientific, the NPR/RWJ/Harvard poll is, and it does point to significant problems when it comes to the availability of nurses at the hospital bedside.

Lawsuit seeks Allscripts CEO's removal

NEW YORK – Healthcor Manangement, LP, one of the largest shareholders of health IT company Allscripts, has filed a lawsuit against the company in an effort to remove CEO Glen Tullman, according to a Reuters report.

According to the news report, HealthCor, which owns 5 percent of Allscripts shares, filed its lawsuit in Delaware's Court of Chancery seeking to strike a company bylaw that requires board nominees be proposed in January. HealthCor had earlier called for Tullman to resign.

The HealthCor move is the most recent in a barrage of troubles that came to light at the end of April when Allscripts fired its board chairman Phil Pead, and three board members resigned in protest. Stock price plummeted by 40 percent. Reportedly unrelated, but critical to analysts, Allscripts' CFO also resigned to take another position outside of healthcare. Analysts downgraded the stock from “buy” to “neutral.”

In its complaint, HealthCor cited Tullman’s failures of execution, and said the chairman and board members who left with him were the ones “most able to protect critical product lines which Eclipsys brought to Allscripts.”

At the crux of Allsripts troubles, insiders say, is the company's failure to integrate products from the two companies after the merger, and failure to integrate the cultures of the two companies, as well.

In a recent interview with Healthcare IT News, Tullman said in his 15 years as CEO of the company his focus has always been on the customers. “They have always been and will always be my primary focus,” he said. “Relative to shareholders, we strive to maintain a constructive dialogue with them and continue to be very focused on generating shareholder value. Once again, the best way to do that is to deliver for our clients.”

New lead poisoning guidelines: What parents should know

The Centers for Disease Control and Prevention's decision to redefine the "action level" for lead exposure in kids has renewed some parents' concerns about the best ways to protect their children.

Children will now be considered at risk � and qualify for careful medical monitoring � if they have more than 5 micrograms per deciliter of lead in their blood. That's half the previous threshold.

Public health leaders have applauded the move, noting that the change will allow governments to take broader action to protect children.

Yet parents may feel more confused about when and how to test their children and homes for lead. Even some experts disagree about the best approach.

In its statement on lead poisoning, the American Academy of Pediatrics says, "Most U.S. children are at sufficient risk that they should have their blood lead concentration measured at least once."

Some health departments issue recommendations about how often to test children for lead, based on test results in the area or particular risks, the group says.

Without that kind of specific guidance, however, kids should generally be tested at age 1 and again at 2, when blood lead concentrations peak, it says.

Philip Landrigan, a leading authority on lead poisoning, agrees that all children should be tested.

While most American children are still well below the new action level, with average blood lead levels of 1.8 micrograms, Landrigan notes there is no safe amount of lead, which can cause brain damage and lower IQ.

"I recommend all children be tested, because you never know," says Landrigan, director of the children's Environmental Health Center at the Mount Sinai School of Medicine in New York.

Many insurance plans don't pay for blood lead testing, Landrigan says. And not all pediatricians offer it. Some refer patients to private labs or the health department.

Blood testing is especially important for poor children, although few of the highest-risk kids are ever tested, according to the pediatrics group.

Most lead poisoning cases occur in substandard housing, where window frames are still coated with lead-based paint, which was banned in 1978. About 25% of U.S. kids fall into this category, the group says.

Yet middle-class neighborhoods aren't immune. Tap water in many neighborhoods in the Washington, D.C., area exceeded safety standards for lead in 2003 and 2004, after lead leached from water pipes.

Test the house, not the child

Jerome Paulson, chairman of the pediatrics group's council on environmental health, agrees that families in homes built before 1950 should be "vigilant" about monitoring for lead. And parents should remember that children can also be exposed outside the home, such as at the homes of relatives or a regular babysitter.

But he says some kids can probably skip the needle stick.

"Kids living in homes built after 1978 don't need to be screened," says Paulson, a pediatrician at children's National Medical Center in Washington. "If the health department is saying, 'We don't see kids in this five-block area or this ZIP code with elevated lead levels,' then we don't need to screen kids in that ZIP code.�

"We really need to focus on preventing the kids from coming into contact with lead," Paulson says. "By testing kids, you're sort of identifying the kids after the fact. It really does make more sense to check the home than to check the child. What counts is the home."

Yet testing the home isn't always simple.

While home lead test kits are popular � sold online and at many hardware stores � they're often not reliable, says Scott Wolfson, spokesman for the Consumer Product Safety Commission. It tested home lead test kits in 2007 and found many produced false results, falsely finding lead in some homes and failing to find lead in others where it was present. The agency hasn't tested newer kits.

Professional contractors can get more accurate lead-testing results, but at a higher price.

The most vulnerable

Landrigan notes that testing allows people to identify sources of lead exposure and remove them.

Most often, testing doesn't lead to treatment, Landrigan says. Because treating children for lead poisoning carries its own serious risks, it is performed only when blood lead levels are extremely high. Most children with blood lead levels above the new threshold will be monitored, rather than treated with medication. Once the lead source is removed, children's blood lead levels typically return to a more normal range within weeks, Landrigan says.

About 90% of lead poisoning comes from lead-based paint in windows, Landrigan says. About 10% comes from home renovations, which can pose a particular risk to untrained do-it-yourselfers trying to fix up older houses, he says.

Sometimes, youngsters chew on peeling paint chips.

More often, children take in lead through paint dust, sometimes in microscopic particles, created when windows are closed or doors are slammed, Paulson says.

Children also can be exposed to lead by playing in the dirt, which may contain lead from car exhaust, factory smoke or even paint dust, if the soil is within a few feet of the house, Paulson says.

Most children exposed to lead are poor.

About 80% of kids with high lead exposures are eligible for Medicaid, according to the pediatrics group, which recommends lead tests for all children eligible for Medicaid. Few get them.

Babies and toddlers are exposed to more lead than adults because they spend more time crawling and playing on the floor, transferring dust to their mouths from everything they touch, Paulson says.

Babies' developing brains are especially vulnerable to lead's toxic effects, which can damage the brain and kidneys and, at higher doses, cause behavioral problems and rob kids of IQ points, Paulson says.

Blood lead levels tend to peak at around age 2, according to the pediatrics group's policy statement on lead exposure. Lead levels tend to decline after this age, as children's growing body size dilutes the concentration of lead in their blood.

School-age children, teenagers and adults, however, face little risk, Paulson says.

And doctors note that children today have dramatically lower blood lead levels than a generation ago.

Before 1970, health officials took action only if children had blood lead levels above 60, Landrigan says.

Glen Campbell serenades Congress at Alzheimer's event

WASHINGTON�Ashley Campbell has the dream of any young musician: to belong to a band making a worldwide tour. Yet her dream has a sad twang to it. Her father is singer Glen Campbell, who went public last June with his diagnosis of Alzheimer's disease.

Campbell, 75, has spent the past year trying to raise awareness about the disease, an incurable, brain-wasting illness that affects 5.4 million people in the USA. That number is expected to triple as the Baby Boomers age.

Ashley Campbell, 25, and two of her siblings have joined their dad onstage as his backup band during his Goodbye Tour. The band was back together here Wednesday night at the Library of Congress for a special performance for members of Congress, put on by the Alzheimer's Association to raise awareness about the disease.

"I think music is therapeutic for him," says Ashley, who plays banjo in the band. "He's definitely sharper when he's on tour than if he's sitting home or playing golf. That's when I see him slipping. But if he can put that guitar in his hands and use his fingers to pick music, he's much better.

"Sometimes he'll get confused when he's singing and might forget some lyrics, but that's when the teleprompter helps him out. And he's not the only musician to use one of those. Not by far."

Ashley says her dad loves the crowds at the concerts � and the feeling seems to be mutual.

"The first night of the tour, I couldn't get over it," she says. "He got the rowdiest standing ovation when he came onstage. People were so supportive of him. I thought maybe it was just because it was the first night.

"Until the next night, when it happened again. And the next night, and the next night."

She says that at a concert before they came to Washington, her dad started singing Rhinestone Cowboy, and a man approached the stage from the crowd.

"He shouted, 'You are a hero, Glen. You are a hero, man.' "

Ashley says music was always part of their household when she was growing up. She played piano and guitar until she got to college. Then she discovered the banjo and bluegrass music.

"Banjo is my instrument now," she says. "When I would play at home, my dad would stand up and say, 'Well, look at you. You're really good on that. You are fantastic.' "

He asks her to invite her friends over, and they play bluegrass music together.

Before the Library of Congress performance, she talked about how important it is for her father to keep doing what he enjoys and to help spread the word about the need to find a cure for Alzheimer's.

"People like Glen Campbell and (basketball coach) Pat Summitt, who are using their voices to advocate for the disease, know it's not going to help them," but it may help others, says Angela Geiger, chief strategy officer for the Alzhiemer's Association. "That takes a special kind of courage."

The sound of courage Wednesday night rocked a jammed auditorium that holds several hundred.

The audience stood and cheered when Campbell came out onstage.

"Thank you," he responded. "I appreciate all of you."

Then he broke into one of his famous songs, Gentle on My Mind, and sang about the "rivers of my mind."

A guitar lick he hit to perfection sent the audience into loud applause again.

"It's important for people to know you can keep doing what you want, that life doesn't end right away when you get Alzheimer's," Ashley says.

Backstage, the adulation continued as Campbell signed autographs.

The Goodbye Tour continues through July.

Coalition presses for privacy as part of stimulus package

WASHINGTON – The Coalition for Patient Privacy is urging Congress to include privacy safeguards with any funding earmarked for healthcare IT in an economic stimulus package. The package was expected to hit President Obama’s desk shortly after inauguration.

The bipartisan coalition, representing more than 30 organizations, individual experts and the Microsoft Corporation, said trust is essential to public adoption of healthcare IT.

In a letter to Congressional leaders, the coalition called for accountability for access to health records, control of personal information and transparency to protect healthcare consumers from abuse.

Michelle De Mooy, a national priorities associate from Consumer Action, said, “Privacy is not just a basic right for all Americans; it has become a basic necessity.”

Obama has called for electronic health records for every American by 2014. In the past few years, Congress has been unable to pass a healthcare IT bill, with much of that difficulty rising from inability to reconcile differences of opinion on healthcare IT privacy.

In Talent Hunt, Some Businesses Offer Health Benefits For Same-Sex Couples

Enlarge The White House/Getty Images

Reaction to President Obama's bombshell that he now supports gay marriage ran the gamut from profound to lighthearted.

The White House/Getty Images

Reaction to President Obama's bombshell that he now supports gay marriage ran the gamut from profound to lighthearted.

President Obama's pronouncement last week in favor of same-sex marriage has no legal effect on employers' decisions on whether to offer benefits to workers' domestic partners.

But some advocates say it could reinforce a decade-long trend toward coverage.

Last year, a little more than half of employers offered health benefits for domestic partners, according to a nationally representative sample of about 3,000 employers surveyed by benefit consultant Mercer. That's up from a little less than one-third in 2010.

The biggest factors driving that change are employers' views on whether such benefits help them attract and retain desirable workers.

 

"Employers started doing this because they felt they needed to be competitive in the labor market, just like with other benefits," said Paul Fronstin of Employee Benefit Research Institute, a think tank in Washington D.C. "I don't see that changing."

The Village Voice newspaper in New York is credited with being the first private employer to offer workers domestic partner benefits in 1982. In 1995, Vermont became the first to offer coverage to state workers.

"There's been a steady growth for a long time," says Joan Smyth, a partner at Mercer. In the early days, some employers worried that adding coverage for domestic partners could make their costs skyrocket by attracting people with higher-than-average health risks, she said, but it didn't turn out that way.

The District of Columbia and almost half of states currently offer benefits to domestic partners or same-sex spouses of state workers, according to the advocacy group Human Rights Campaign.

Same-sex partners of federal workers are not eligible for coverage under the Federal Employees Health Benefits Program because the Defense of Marriage Act, passed in 1996 and signed into law by President Bill Clinton, defines marriage as a legal union between a man and woman, the FEHB website says.

That law is being challenged and may well end up before the Supreme Court. The Obama administration has said it will not defend the statute.

The proportion of companies offering coverage varies widely by region and industry. In the Mercer survey, coverage of same-sex partners was most common in the West, with 79 percent of large employers offering such benefits. It was least common in the South, at 28 percent.

Among manufacturing firms, for example, the coverage rate ranged from a high of 96 percent for pharmaceutical companies to 18 percent for machinery and heavy equipment makers.

Public sector jobs had a lower rate of coverage, averaging 26 percent across state, county and municipal workers, the Mercer survey found.

While Smyth at Mercer doesn't think the president's pronouncement will sway employers, the Human Rights Campaign's state legislative director Sarah Warbelow has a different take. "Hearing the president supports this as well makes this even easier for corporations to get on board," says Warbelow, adding that 58 percent of Fortune 500 companies currently offer domestic partner benefits. Some of those companies limit those benefits to same-sex couples, while others include domestic partners of opposite sexes.

N.Y. man defrauds Medicare of $70,000 in medical device reimbursements

BOSTON – Michael McKay, 32, of Saratoga Springs, N.Y.. pleaded guilty in district court on May 11 for forging physician’s chart notes to make Medicare or private carrier claims qualify for reimbursements for bone growth stimulator medical devices.

According to the Office of the Inspector General (OIG), between 2008 and 2010, McKay collected $70,000 in false Medicare claims.

District Judge Denise Casper has scheduled McKay’s sentencing for Sept. 6, 2012. McKay faces up to 10 years in prison, to be followed by three years of supervised release; a $250,000 fine; asset forfeiture and restitution.

Had the case proceeded to trial the government’s evidence would have proven that between 2008 and 2009 McKay was a territory manager for a company that manufactured and distributed bone growth stimulator medical devices, according to the OIG. McKay’s territory included New York, Pennsylvania and Ohio.

The device that McKay sold was intended to assist patients with bone fractures that did not heal properly, according to the OIG. Medicare has specific guidelines describing when it will pay for this device for one of its beneficiaries. Many private insurance carriers follow these guidelines as well. McKay often received orders for patients that did not satisfy these guidelines. When this happened, McKay forged the patients’ medical records to make it appear as though the order met Medicare or private payer guidelines.

McKay altered physician’s chart notes, changing the dates of patient visits and inserting false diagnoses, officials from the OIG said. McKay also created phony medical chart notes, describing patient visits that did not occur.

The medical device company fired McKay after it discovered his fraud, OIG officials said. After that, McKay’s supervisor and another territory manager, Derrick Field, concocted a scheme in which McKay continued to submit orders from doctors in his former territory, but he submitted them through Field.

Field, who was also convicted for healthcare fraud in a similar scheme, submitted the orders to the device company and split the commissions with McKay. McKay continued to forge patients’ medical records even after he was fired by the company for this conduct, according to the OIG.

A New Tool to See Where We’ve Been, Where We Are, And Where We’re Going

Today, we released a new, first-of-its-kind web tool that will give all Americans a new, user-friendly way to view health data and track how the national health system is changing.

The Health System Measurement Project allows people to track the progress we are making to provide all Americans with access to affordable, high-quality health care and to reduce health disparities. Gathering� this information together in one place�and presenting it in a format that�s accessible and easy to navigate�not only makes data easier to understand, but it�s part of the Obama administration�s commitment to transparency and accountability.

One of the ways the Measurement Project accomplishes this is by making it easy for visitors to the site to see what kind of progress the Department of Health and Human Services (HHS) is making on our national strategy plans. The tool displays information on trends in the control of high blood pressure and high cholesterol that are a focus of the National Quality Strategy and the National Prevention Strategy, and allows users to break down information about infants born at a low-birth weight by race and ethnicity, to see how HHS is meeting its Disparities Action Plan goals.

Users of the site can search for information on health care topics they�re interested in and find regional or national-level data broken down by age, income level, and insurance coverage status.

The Measurement Project also makes it easy for site users to find information that relates to specific portions of the Affordable Care Act. For example, someone viewing the site could use the web tool to look at data by age group, making it easy to see the effects of allowing children up to age 26 to gain coverage through their parents� health plan.

Health System Measurement Project chart showing
young adult health insurance coverage trends from 2006 to 2010.

You can access the Health System Measurement Project at healthmeasures.aspe.hhs.gov. Once on the site, you can learn more about its 10 topical areas and explore measures�like coverage, innovation, and quality--within those areas. You can also break the information down further and search for population characteristics, such as age group, income level, and insurance status. Whether you�re a state policymaker, health care provider, or employer, you can find information intended specifically for you in the �data for you� section. You can also use the site to download datasets and share study results via social media.

We will only make our health care system stronger if we know where we�ve been, where we are, and where we�re going. The Health System Measurement Project gives all of us the tools to track and assess our progress.

AMA calls for 2-year extension of ICD-10 deadline

WASHINGTON – The American Medical Association (AMA) has asked the federal government to delay the implementation deadline for ICD-10 from Oct. 1, 2013, until Oct. 1, 2015, "at a minimum."

The AMA asked for this two-year compliance deadline in a May 10 comment letter to the Centers for Medicare & Medicaid Services (CMS). "A two-year delay of the compliance deadline for ICD-10 is a necessary first step," AMA officials wrote to CMS Acting Administrator Marilyn B. Tavenner.

During the delay AMA proposes, officials urge CMS to institute a process to engage all relevant, stakeholders including physicians, to assess whether an alternative code set approach is more appropriate than the full implementation of ICD-10.

Earlier this year, CMS nodded to rolling back the deadline from Oct. 1, 2012, to Oct. 1, 2013, delaying compliance by one year.

In November 2011, AMA’s House of Delegates voted to call for a  repeal of the federal requirement to move to ICD-10 so that physicians and other stakeholders could assess an appropriate alternative.

Physicians will be overwhelmed with the financial and administrative burdens of a transition to ICD-10 while they are also facing implementation of “a number of inadequately aligned” federal programs, AMA officials wrote. The burdens are further compounded by a proposed 31 percent Medicare reimbursement cut proposed for Jan. 1, 2013.

 

Face transplant patient can feel daughter's kisses

BOSTON(AP)�A Texas man who had a face transplant a year ago says now he can feel his daughter's kisses.

Dallas Wiens (WEENS) of Fort Worth was at Brigham and Women's Hospital in Boston on Monday to follow up with his transplant team.

He had the nation's first full face transplant a year ago and says he can use his face more than he expected. His face was burned in 2008 when his head touched a high-voltage power line while standing in a cherry picker. He was also blinded.

He says feeling his daughter's kisses has brought him to tears more than once. He also says he can go out with family and friends and not worry about what anyone thinks.

His doctor says every time the team sees him he can do and feel more things.

Reaffirming Our Commitment to Fighting – and Preventing – Breast Cancer

October is National Breast Cancer Awareness Month � a time to remember those who have lost their lives to breast cancer, those who are battling it now, and to celebrate with those who have survived. It is also a time to reaffirm our commitment to fighting breast cancer and to remind ourselves of the importance of prevention and early detection.

In recognition of Breast Cancer Awareness Month, I had the privilege of joining actress Jennifer Aniston, who recently directed a new Lifetime Original movie exploring a family affected by breast cancer, Dr. Jill Biden, and a small group of breast cancer survivors, providers and others, to discuss lessons learned from those who have been treated for breast cancer. We also talked about how important it is to coordinate health care, so we can do more to treat and prevent breast cancer.

The White House, seen from the North Grounds, is bathed in pink light in honor of�
Breast Cancer Awareness Month, Oct. 14, 2010. (Official White House Photo by Lawrence Jackson)

Breast cancer remains one of the most frequently diagnosed cancers among American women and despite remarkable advances in treatment and prevention, it remains the second leading cause of cancer death.

Regular mammography screenings help ensure that breast cancer does not take the lives of more women. The chance of successful treatment is highest when breast cancer is detected early.� However, only about 67 percent of women aged 40 or older have had a mammogram in the last two years. If 90 percent of women 40 and older received breast cancer screening, 3,700 lives would be saved each year. Yet in a time when budgets are tight, costs � even moderate co-pays � deter many patients from receiving these important screenings.

Thanks to the health reform law, the Affordable Care Act, most private health plans and Medicare now cover women�s preventive health care � such as mammograms and screenings for cervical cancer �with no co-pays or other out-of-pocket costs. This means that women can get services they need to detect or prevent breast cancer before it spreads or becomes fatal, without worrying that they�ll have to pay for these services out of their own pockets.� This year to date, 3.8 million women in traditional Medicare have gotten a free mammogram.�

In addition to regular mammography screenings, there are steps that women can take that may reduce their risk of developing brea st cancer. Women should talk with their doctor about their personal risk for breast cancer, when to start having mammograms, and how often to have them. If they are found to be at increased risk of breast cancer because of medical or genetic history, they should talk with their doctor to decide what the best options are to reduce their breast cancer risk. With the release of the new Women�s Preventive Services Guidelines, a well-woman visit is available� so women have the opportunity to discuss their health care needs with their medical provider�at no additional cost.

Women also have new rights and protections against insurance company abuse under the Affordable Care Act. If diagnosed with breast cancer or another illness, women are now protected from having their coverage taken away if they get sick and when they need coverage the most.

The health reform law is also helping women who are going, or have gone through, costly breast cancer treatment. Today, insurance companies can�t impose lifetime limits on coverage.�And in most health plans, annual limits will be restricted. This means that your health insurance will be there right with you, covering your treatments, as long as you need it.

Beginning in 2014, it will be illegal for insurance companies to discriminate against anyone with a pre-existing condition. In the past, insurance companies could deny coverage to women due to pre-existing conditions such as breast cancer, and if coverage was attained, insurance companies set lifetime and annual limits on what the companies would spend for benefits.

These changes are making real differences in the lives of American women and families. Prevention, coupled with continued research, will help save more lives and improve the quality of life for all of us touched by breast cancer.

CMS to develop eligibility tools for insurance exchanges

WASHINGTON – The Centers for Medicare and Medicaid Services plans to develop verification data and services to support coverage and eligibility infrastructure for health insurance exchanges and seeks industry information about applications that are available.

A solution that verifies eligibility for qualifying coverage in an employer-sponsored plan is part of the process for determining whether an individual qualifies for advance payment of the premium tax credit that is available to support the purchase of health plans through the exchanges.

[See also: Exchange deadline creeps closer]

CMS wants to identify authoritative data sources that can be used or adapted to meet the verification requirement and also how to develop new data sources that could fulfill that condition, according to an April 30 announcement for request for information in Federal Business Opportunities. Responses are due May 21.

Among solutions that the Health and Human Services Department has proposed in a rule describing health insurance exchanges is development of a database that contains authoritative data to assure employer-sponsored coverage.

The Patient Protection and Affordable Care Act did not require this data, so population of a potential database would be voluntary. And no data sources currently exist that contain comprehensive information about access to employer-sponsored coverage or the affordability and minimum value of such coverage, according to the notice.

[See also: Insurance exchange rule unveiled]

Under the health reform law, states must have operational capability of their online marketplace to compare and purchase health coverage by October 2013.

One example of how verification might work is that an exchange could use a database to check applicant attestations about access to employer-sponsored coverage. A business service request generated by the exchange would check private and public data sources through a CMS data services hub to confirm the accuracy of the data that was submitted. These data sources could include the state Directory of New Hires or state quarterly wage databases. 

CMS also seeks information about technology or business process applications that can verify the current income of individuals and households seeking insurance through the qualified health plans offered through the exchange, according to an April 23 request for information. The process is similar to that for verification for employer-sponsored coverage and the use of a CMS data services hub to confirm data. Responses are due May 14.

Exchanges must be able to determine also whether individuals are eligible to receive advance payments of the premium tax credit, cost-sharing reductions and exemptions from the individual responsibility requirement. Income levels are available from individual confirmation and data from federal, state and commercial sources.

Processes for eligibility and income verification need to be streamlined and coordinated across HHS, the exchanges, state Medicaid and Children’s Health Insurance Program agencies. Yet the information required from an applicant must be the minimally necessary to support eligibility and enrollment procedures across those programs.

[See also: Health insurance exchanges mired in political battle]

Why are you Thankful?

If you follow @HealthCareGov on twitter, you already know some of the many reasons why we are thankful for the health care law, the Affordable Care Act. From preventive benefits to strengthening Medicare, the Affordable Care Act is helping keep Americans healthy and protecting them from some of the worst abuses of the insurance industry.

This month, we�re highlighting the many reasons to be thankful for these new benefits. �So we put out the call asking you to give us a few examples about the new health care benefits you�re thankful for, and share stories about how you�ve been helped by the law. Already, on we�ve heard from hundreds of you.� Using the hashtag #ThanksHCR, here are just a few examples of what people across America have said on Twitter:

@MaineCAHC: #ThanksHCR for keeping Julie on her mom�s insurance so she can get the care she needs http://t.co/lGO4F5JN

@TxWellHealthy: In Texas, 149,000 young adults gained coverage due to ACA allowing kids under 26 to stay on parents� policies. #ThanksHCR

@AmerAcadPeds: Thanks to health reform, insures can�t deny coverage to kids due to pre-existing conditions. #ThanksHCR

@ABCardio1: Thanks to health reform, people with Medicare get a free annual wellness visit, AKA more time with their doc http://1.usa.gov/uRd3go #ThanksHCR

@NHCouncil: This thanksgiving season NHC gives thanks for ACA policies that help people with #chronic conditions. #ThanksHCR

@whereisthao: #ACA in effect - calling out unfair rate hikes by health ins industry! ow.ly/7BzWs #ThanksHCR

@HealthPolicyHub: #ThanksHCR for protecting #Medicare benefits for seniors and providing free preventive care with no co-pay.

@RWV4HealthCare: Love the fact that children can stay on their parents' insurance plans till age 26! #thanksHCR

@apiahf: Thanks 2 #HCR, people w #Medicare get discounts on prescription drugs and a free annual wellness visit. #ThanksHCR

@VA Organizing: #ACA is helping to protect patients from medical errors & making hospitals more reliable, less costly. 1.usa.gov/sQNMtK #ThanksHCR

So this Thanksgiving, as you gather around the table with family, friends, and great food, remember to share why you are thankful. Talk to your loved ones about the key features of the law that can help keep them healthy. And keep sharing your stories about why you are thankful for the many new benefits in the health care law by sending a tweet using the hashtag #ThanksHCR.

Kalorama: EMR market to grow by 14 percent annually through 2012

NEW YORK – Kalorama Information forecasts the EMR market to grow by 14.1 percent annually through 2012, from $9.5 billion in 2007.

The emerging personal health record trend will have a vast impact on the electronic medical records market and on healthcare in the upcoming year, according to the New York-based marketing research firm.

The report, "U.S. Markets for EMR Technology," examines how the focus of ownership of medical records is shifting from one that is distributed among various healthcare providers to one that is shared and controlled by both the patient and the provider.

Patients' and physicians' interest in viewing records online has increased, since giving patients online access to their own charts is expected to enhance the doctor-patient relationship and reduce healthcare costs.

"The driver for EMR sales has always been hospital-side, as in 'this can reduce your costs,'" said Bruce Carlson, publisher of Kalorama Information. "That's still true, but with PHRs, the driver is also on the consumer side, as in 'this can make your organization seem friendly and modern to healthcare consumers.'"

The Affordable Care Act Will Bring Down Costs

Over the last year, much of the attention on the Affordable Care Act has focused on reforms that are helping Americans get health coverage.� These provisions are already making a big difference in Americans� lives, from ending some of the worst insurance company abuses to giving many young people the freedom to stay on their parent�s health coverage plans until age 26.

But just as important, the Affordable Care Act is also bringing down health care costs for families, businesses, and government.

Let�s look at the facts:

The independent, non-partisan Congressional Budget Office � Congress�s official authority on the budget � estimates that provisions in the law will reduce the deficit by $143 billion over its first 10 years and by $1 trillion over the next two decades.

And the Medicare trustees recently reported that the Affordable Care Act has added eight years to the life of the Medicare Trust Fund.

How does it do this?

First, the law bolsters the Obama Administration�s historic effort to crack down on Medicare fraud that already returned a record $4 billion to the program in 2010.

Second, it puts an end to wasteful subsidies to private insurance companies.

Third, it provides a historic level of support for cutting-edge delivery and payment reforms, like Accountable Care Organizations and bundled payments, that allow doctors and nurses to deliver care more effectively.�

And that�s just the start.� As 272 of America�s top economists said in a letter earlier this year: �the ACA contains essentially every cost-containment provision policy analysts have considered effective in reducing the rate of medical spending.�

The health care law is also bringing down health care costs for America�s businesses.

Many small businesses are already taking advantage of tax credits in the new law that can cover as much as 35 percent of their health insurance premiums.�� In 2010 and 2011 alone, small businesses could save $6 billion.�� And that number will rise as we move towards 2014 when small businesses will be eligible for tax credits of up to 50% of their premiums.

Meanwhile, the claim that the Affordable Care Act gives large companies incentive to drop health coverage has been thoroughly debunked by several independent experts:

Here�s what the Rand Corporation said: "The percentage of employees offered insurance will not change substantially, but a small number of employees in small firms (defined as those with fewer than 100 employees in 2016) will obtain employer-sponsored insurance through the state insurance exchanges."

And here�s the Urban Institute: "Some have argued that the Patient Protection and Affordable Care Act would erode employer-sponsored insurance (ESI) by providing incentives for employers to stop offering coverage. Others have claimed that most businesses would face increased costs as a result of reform. A new study finds that overall ESI coverage under the ACA would not differ significantly from what coverage would be without reform."

Most importantly, the law will help all businesses, large and small, by bringing down the cost of care.� For American companies whose international competition often spend 40 cents on health care for every dollar spent in the US, this will provide a much needed competitive boost.

Finally, the law will bring down costs for American families.

New Affordable Insurance Exchanges will level the playing field for individuals and families purchasing coverage in the health insurance market and allow families who have been locked out and priced out of the market to get affordable coverage.�

And for middle-class families that need help paying for coverage, the law also provides unprecedented tax relief that will cut the cost of insurance while guaranteeing access to basic health benefits.

In addition, the Affordable Care Act has given states new resources to review and reject huge premium hikes and told insurers to cut their administrative costs and spend the bulk of consumer premiums on health care, instead of advertising and large CEO bonuses.

We�re already seeing the fruits of that labor with a sharp slowdown in the growth of premiums in many states across the country.

For too long, Americans have watched health care costs skyrocket with no end in sight.� The Affordable Care Act will stabilize costs, reducing the deficit, helping businesses compete and invest, and freeing families from the fear that an illness or injury could send them into bankruptcy.�

That�s good for our health and our economy.

How did the challenge to the Affordable Care Act ever make it to the U.S. Supreme Court?

In 2009, when someone asked Nancy Pelosi a question implying that health reform legislation might be unconstitutional, she replied: "Are you serious?"

Pelosi wasn't alone. At the outset, many legal scholars considered the challenge to the Affordable Care Act (ACA) both "implausible" and "frivolous."

But over the next two years, the notion that state courts might strike down the ACA took on a life of its own. Most people had only a hazy idea of what was actually in the legislation; nevertheless the idea of "health reform" inspired heated rhetoric. Soon, state attorneys general and governors responded to the political opportunities, banding together to make what Slate Senior Editor Dahlia Lithwick calls, "novel arguments in the form of what was always a constitutional Hail Mary pass … It's no accident that until the lower district courts started striking down the act, none of the challengers really believed that they could succeed."

Yet somehow, this week, the highest court in the land is hearing oral arguments in a case that even supporters viewed as a long shot. How did this happen?

The media played a major role, fanning political passions by quoting every challenge � including the absurd claim that the bill called for "death panels." As Rachel Maddow observed Monday night: this case was "built up as the Super Bowl of American partisan politics." Thus, the Supreme Court was left with little choice: it had to hear "The Case of the Century."

Why media fanned the flames

Why did reporters latch onto the story? First, the media is in the business of selling newspapers and air time. Health reform is a "hot-button" topic.

Secondly, as Linda Greenhouse explains in a scathing New York Times�Op-ed: "Journalistic convention requires that when there are two identifiable sides to a story, each side gets its say, in neutral fashion, without the writer's thumb on the scale" � even when "one side of a controversy obviously lacks merit."�(This is what some call "balanced" reporting.)

"Journalistic accounts of court cases … treat the arguments on both sides with equal dignity," explains Greenhouse, a Pulitzer Prize winner who has covered the Supreme Court for 30 years, and now teaches at Yale's law school. "So it's perhaps not surprising that just about half the public apparently believes that … the individual mandate is unconstitutional." But Greenhouse comes down on the side "truth-telling" over "balance":

"I'm here to tell you: that belief is simply wrong. The constitutional challenge to the law's requirement for people to buy health insurance … is rhetorically powerful but analytically so weak that it dissolves on close inspection. There's just no there there."

Nevertheless the media succeeded in blowing the story up, and in two years, what constitutional experts thought was a non-story became a Supreme Court case.

Legal minds saw a ‘non-story'

Over that time, the U.S. Constitution hasn't changed. The challenge is as thin as it was in 2010, when Charles Fried, who served as soliciter general under President Ronald Reagan, told ABC News that "anyone" who questions the constitutionality of the Affordable Care act "is either ignorant � I mean, deeply ignorant � or just grandstanding in a preposterous way. It is simply a political ploy and a pathetic one at that."

Prominent legal scholars also spoke out: "States can no more nullify a federal law like this than they could nullify the civil rights laws" said Timothy Stoltzfus Jost, a health law expert at Washington & Lee University School of Law. �Mark A. Hall, a law professor at Wake Forest agreed: "There is no way this challenge will succeed in court," adding that the cases brought by the states seem "sort of an act of defiance, a form of civil disobedience if you will." In other words, this was a Tea Party demonstration.

Initially, reform's opponents lost in two state courts where judges appointed by Democrats ruled against them. They also lost their first case in an Appeals Court where Laurence Silberman, a conservative Reagan appointee who is regarded as a serious constitutional scholar, concluded that there is "no textual support" in the constitution "that mandating the purchase of health insurance is unconstitutional.

But other Republican judges sided with the challengers ��most importantly in Florida, where that state and 26 partner states won. The mandate was no longer a Tea Party talking point; it had become an issue that Congressional Republicans took seriously.

This was not always the case. Until very recently, scholars who specialize in the history of health reform explain,�the proposition that "it is wrong to allow people who can afford insurance to shift the cost of their care to others by refusing to provide responsibly for their future health needs" enjoyed "broad bi-partisan support … Indeed, ten current Republican Senators who now oppose the minimum coverage requirement as unconstitutional previously sponsored or cosponsored legislation that included an individual mandate."

‘No free riders' means everyone must pay

Republicans, like Democrats understood that at some point in time, virtually everyone will need health care. If we don't want to let "free riders" impose the cost of their care on all of us, we must ask everyone to buy coverage.

Yesterday, Chief Justice John Roberts asked if the government has the power to require that everyone buy a cell phone. The answer is "No," because cell phones are not a necessity. If someone doesn't have one, the rest of us don't feel obliged to buy one for him. But health care is a necessity. And in our society, we are not inclined to leave people to bleed to death on the sidewalk because they didn't buy insurance.

It is only recently, as healthcare reform became "Obamacare," that conservatives have disavowed a mandate they once embraced. In other words, it seems that they are objecting, not to the idea everyone who can afford it should purchase insurance, but rather to the fact that President Obama has succeeded in doing what so many past presidents have tried and failed to do.

Could it be that this debate is really not about the Constitution, but instead, about what Senate Minority Leader Mitch McConnell has called Republicans' "number one goal" ��to get Obama out of the White House?

That said, I remain extremely hopeful that when the justices hand down a decision in June, they will act as officers of the court, not as politicians.

Celebrating National Health Center Week in Philly

During National Health Center Week, representatives from the Department of Health and Human Services traveled around the country to attend events honoring the great work that Community Health Centers do day in and day out.

I traveled to Philadelphia to participate in the 4th Annual National Health Center Week Celebration hosted by the City of Philadelphia and the Health Federation of Philadelphia in the regal Mayor's reception room. There was an impressive turnout in spite of a torrential rainstorm, which is a testament to how much the community values and appreciates the health centers. A special part of the program was the Youth Poster Contest Award Ceremony. I am surrounded by the winning submissions by the young artists, the topic of which is "Community Health Centers: Health Care for All." It was an honor to be recognized by my friend State Senator Vince Hughes who is fortunate to represent several students who created the winning entries. Senator Hughes made a great point in recognizing the combination of the creation of great art and community service.�

HHS Regional Director Joanne Grossi (center) listens as Spectrum Health�Services� Phyllis Carter (at podium) praises student artists for their work�in creating posters depicting the value of community health centers while�U.S. Representative Chaka Fattah (left) looks on.

I was pleased to point out the impressive number of people who benefit from community health centers and how the ACA helped to make that happen. I was also honored to announce that two organizations in Philadelphia were receiving a total of $540,000 for new access points. The highlight of the event occurred when Congressman Chaka Fattah offered his perspective on the value of community health centers and pledged his unwavering support for the Affordable Care Act. Congressman Fattah related his conversations with President Obama on their shared commitment to health care for all. The program culminated with Deputy Mayor Dr. Donald Schwarz doing an excellent job as awards presenter and ensuring the young artists received the recognition they deserved for their poignant works of art, which reminded us all of how community health centers continue to improve and save lives every day.

Sleep lessens the effect genes have on weight

Sleeping more may help you fight a genetic predisposition to gain weight, a new study says.

"The less sleep you get, the more your genes contribute to how much you weigh. The more sleep you get, the less your genes determine how much you weigh," says lead author Nathaniel Watson, a neurologist and co-director of the University of Washington Medicine Sleep Center in Seattle.

Previous research has shown the connection between sleep and weight, but this study looks at the role of genetics.

Watson and his colleagues analyzed self-reported data on height, weight and sleep duration of 604 pairs of identical twins and 484 sets of fraternal twins in the University of Washington Twin Registry.

Getting enough shut-eye

Sleep needs vary among individuals, but here are some nightly guidelines:

Source: National Sleep Foundation

People were considered to get short sleep if they slept less than seven hours a night; normal sleep if they slept seven to 8.9 hours, long sleep if they slept nine hours or more. The average age of participants was about 37 years; average sleep duration was 7.2 hours a night.

Among findings published online today in the journal Sleep, from the American Academy of Sleep Medicine:

�Those who slept longer at night had lower body mass index (BMI), based on weight and height, than those sleeping less.

�People who sleep less increase their genetic risk of an elevated BMI, Watson says.

�For twins averaging more than nine hours of sleep, genetic factors accounted for about 32% of weight variations; for those sleeping less than seven hours, genetic factors accounted for 70% of weight variations. For those sleeping seven to nine hours, 60% of the variation was due to genetic factors. Other factors that affect BMI include environmental ones.

Both sleep need and BMI are inherited traits, Watson says. "But we see differences in how much twins weigh based on their sleep duration," he adds.

He says researchers don't know which genetic pathways involving weight are influenced by sleep, but they might include those involving hunger, satiety, fat storage, metabolism or other physiological functions.

Scientists have known for years that sleep deprivation increases levels of a hunger hormone and decreases levels of a hormone that makes you feel full. The effects may lead to overeating and weight gain.

The new findings are another good reason to be sure you get enough shut-eye every night, says sleep expert Jodi Mindell, a psychology professor at Saint Joseph's University in Philadelphia. "If you're trying to lose weight, getting enough sleep gives you a fighting chance."

Providing Better, More Coordinated Care Through Pioneer ACOs

Anyone who has multiple doctors probably understands the frustration of fragmented and disconnected care: lost or unavailable medical charts, trouble scheduling an appointment or talking to a doctor, duplicated medical procedures, or having to share the same information over and over with different doctors.

Accountable Care Organizations (ACO�s) are designed to lift this burden from patients, while improving the partnership between patients and doctors in making health care decisions. People with Medicare will have better control over their health care, and their doctors can provide better care because they will have better information about their patients� medical history and can communicate more readily with a patient�s other doctors. Doctors in ACOs aren�t penalized for spending more time with patients � they�re rewarded for it.

Starting today, provider groups from across the country will get support in providing better, more coordinated health care through an initiative called the Pioneer Accountable Care Organizations (ACO) Model. This initiative will advance the best practices of primary care doctors, specialists, hospitals and other providers in coordinating care for patients with Medicare.

There are 32 leading health care organizations from across the country that will participate in this new initiative made possible by the Affordable Care Act.� They represent health system leaders in innovation, providing highly coordinated care for patients at lower costs. This initiative will help some of our nation�s best health care systems become even better.

For example, Sharp Healthcare has taken innovative steps toward engaging patients in their care through a patient portal.� In this portal, patients can get information about their care, and easily access information about their health and steps they can take to keep themselves healthy.� By empowering patients to know more about their care, Sharp is partnering with their patients to make the best possible decisions about their health.

Medicare beneficiaries aligned with Seton Health Alliance in Central Texas will continue to have access to four After Hours Clinics, where patients can be seen in a clinic setting staffed by physicians after regular hours. Services available 24 hours a day will include phone nurses, online education resources, online appointment requests and online bill-pay.

Under this model, ACO�s take greater risk and get greater rewarded than in the Medicare Shared Savings Program for how well they�re able to improve the health of their Medicare patients and lower health care costs. We�ll test several different models to determine which best meets the goals of better care and reduced growth in costs.

Selected Pioneer ACOs include physician-led organizations and health systems, urban and rural organizations, and organizations in various geographic regions of the country, representing 18 States and the opportunity to improve care for 860,000 of Medicare beneficiaries.

For the final list of participating Pioneer ACOs and more information about the Pioneer ACO Model, check out our fact sheet is posted at or you can visit this page.

For more information about the CMS Innovation Center, visit innovations.cms.gov.

Health reform: a huge victory for women

Women pay dearly for being women

When they buy their own health insurance in the individual market, women must lay out an extra $1 billion a year, simply because they are women.

The male body has long been considered the "standard" for health care coverage. Having a woman's body is seen as an expensive anomaly, and women pay dearly for being different.

When they buy their own health insurance in the individual market, women must lay out an extra $1 billion a year, simply because they are women. Some argue that this is fair: after all, a woman could become pregnant, and labor and delivery are costly.

But the truth is that, even when maternity benefits are excluded, one-third of all health plans charge women at least 30 percent more, according to a report released just last month by the National Women's Law Center.

In 36 states, "92 percent of best-selling plans charge 40-year-old women more than 40-year-old men," the Center reports, and "only 3 percent of these plans cover maternity services … One plan in South Dakota charges a woman $1252.80 more a year than a 40-year-old man for the same coverage."

Today, less than half of American women can obtain affordable insurance through a job, which explains why millions buy their own insurance in the individual market. In that market, just 14 states ban gender rating: �California, Colorado, Maine, Massachusetts, Minnesota, Montana, New Hampshire, New Mexico, New Jersey, New York, North Dakota, Oregon, Vermont, and Washington.

Pricing based on gender also plagues the small group market, where insurers frequently jack up premiums if a small or mid-size business employs too many women. This means that many of these employers just can not afford to offer insurance. Only 17 states address the problem.

Insurers explain that women cost them more, even if policies don't cover maternity, because "they are more likely to visit doctors, get regular check-ups, take prescription drugs, and have certain chronic illnesses."

In other words, women are penalized for taking care of themselves, As for those "female chronic ailments," men also are more vulnerable to certain diseases ��including many caused by smoking (23 percent percent smoke vs. 17 percent of women).

But insurers ignore male vulnerabilities. As Soraya Chemaly points out on BlogHer: "In most markets if you are a non-smoking female you will pay more than a smoking male of the same age because you possess ovaries and not testes."

And that is if you can get insurance.

Next: Pre-existing conditions: rape, C-sections, beatings?

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Doctors want to redefine autism; parents worried

One child doesn't talk, rocks rhythmically back and forth and stares at clothes spinning in the dryer. Another has no trouble talking but is obsessed with trains, methodically naming every station in his state.

Autistic kids like these hate change, but a big one is looming.

For the first time in nearly two decades, experts want to rewrite the definition of autism. Some parents fear that if the definition is narrowed, their children may lose out on special therapies.

For years, different autism-related labels have been used, the best known being Asperger's disorder. The doctors working on the new definition want to eliminate separate terms like that one and lump them all into an "autism spectrum disorder" category.

Some specialists contend the proposal will exclude as many as 40 percent of kids now considered autistic. Parents of mildly affected children worry their kids will be left out and lose access to academic and behavioral services � and any chance of a normal life.

But doctors on the American Psychiatric Association panel that has proposed the changes say none of that would happen.

They maintain the revision is needed to dump confusing labels and clarify that autism can involve a range of symptoms from mild to severe. They say it will be easier to diagnose kids and ensure that those with true autism receive the same diagnosis.

With new government data last week suggesting more kids than ever in the U.S. � 1 in 88 � have autism, the new definition may help clarify whether the rising numbers reflect a true increase in autism or overdiagnosis by doctors.

There is no definitive test for autism. The diagnosis that has been used for at least 18 years covers children who once were called mentally retarded, as well as some who might have merely been considered quirky or odd. Today, some children diagnosed with autism may no longer fit the definition when they mature.

"We're wanting to use this opportunity to get this diagnosis right," said Dr. Bryan King, a member of the revision panel and director of the autism center at Seattle Children's Hospital.

The revision is among dozens of changes proposed for an update of the psychiatric association's reference manual, widely used for diagnosing mental illnesses. The more than 10,000 comments the group has received for the update mostly involve the autism proposal, with concerns voiced by doctors, researchers, families and advocacy groups. A spokeswoman declined to say whether most support or oppose the autism revision.

The group's board of trustees is expected to vote on the proposals in December, and the updated manual is to be published next year.

Among the proposed changes:

� A new "autism spectrum disorder" category would be created, describing symptoms that generally appear before age 3. It would encompass children with "autistic disorder," now used for severe cases, plus those with two high-functioning variations.

A diagnosis would require three types of communication problems, including limited or no conversation and poor social skills; and at least two repetitive behaviors or unusual, limited interests, including arm-flapping, tiptoe-walking and obsession with quirky topics.

� Autistic disorder and high-functioning variations � Asperger's disorder and PDD-NOS, or "pervasive developmental disorder not otherwise specified" � would be eliminated, but their symptoms would be covered under the new category.

Asperger's kids often have vast knowledge about a quirky subject but poor social skills; PDD-NOS is notoriously ill-defined and sometimes given to kids considered mildly autistic.

� Another new category, "social communication disorder," would include children who relate poorly to others and have trouble reading facial expressions and body language. A small percentage of children now labeled with PDD-NOS would fit more accurately into this diagnosis, autism panel members say.

They say the changes make scientific sense and are based on recent research.

Opponents include older kids and adults with Asperger's who embrace their quirkiness and don't want to be lumped in with more severe autism, and parents like Kelly Andrus of Lewisville, Texas. Her son, Bradley, was diagnosed with mild autism a year ago, at age 2.

"I'm really afraid we'd be pushed out of the services we get," she said. That includes a free preschool program for autistic kids and speech and occupational therapy, which cost her $50 a week. The family has no medical insurance.

Opponents also include a well-known Yale University autism researcher, Dr. Fred Volkmar, who was on the revision panel but says he was unhappy with the process and quit. "I want to be sure we're not going to leave some kids out in the cold," he said.

Volkmar is senior author of a study suggesting that the revision would exclude nearly 40 percent of children with true autism. But members of the revision panel have challenged Volkmar's methods, saying he relied on outdated data from two decades ago.

One major advocacy group in the field, Autism Speaks, said it is awaiting further research on the effects of the revisions before deciding whether to endorse them.

Dr. James Harris, a panel member and founding director of the developmental neuropsychiatry program at Johns Hopkins University, said the proposal will provide a better label for children who really only have communication problems.

"I don't want a child labeled as autistic, which suggests a chronic, lifelong problem, when he has a social communication problem that may get better if he has proper services and his brain matures," Harris said.

Harris said these kids don't need intensive autism therapy but should be eligible for other types of special education typically offered in public schools.

Dr. Daniel Coury, chief of developmental and behavioral pediatrics at Nationwide Children's Hospital in Columbus, Ohio, said parents have valid concerns because insurance companies and schools may not immediately recognize that children receiving the new diagnosis may need special services.

"So there may potentially be a lag time where services would not be available," he said.

He noted it is already difficult for many families to get costly autism therapy. Some insurers don't cover it, and many financially strapped school districts have cut special education.

The first ever National Prevention Strategy

Tomorrow, June 16, we are taking steps forward to move the nation away from a focus on disease and illness to a focus on wellness and prevention.

HHS Secretary Sebelius, EPA Administrator Lisa Jackson, US Senator Tom Harkin, Melody Barnes, Domestic Policy Adviser and the Director of the Domestic Policy Council at the White House and Surgeon General Regina Benjamin will join with other administration officials to unveil the first ever National Prevention Strategy.

The National Prevention Strategy, called for under the Affordable Care Act, outlines the ways that public and private partners can help Americans stay healthy and fit and improve our nation�s prosperity.

Tune-in to www.hhs.gov/live to watch this event live at 11:00am EDT on June 16th.

Hate Obamacare? Rip up your rebate check.

If you're disgusted by Obamacare, rip up the rebate check delivered by your insurance company ... brought to you by the reform law's medical loss ratio.

The time is perfect for everyone who despises Obamacare to demonstrate loudly and clearly, once and for all, your total disgust for the health reform law. It's time to vote with your paycheck.

Wait. Strike that. It's even easier to show your distain for the Affordable Care Act: simply vote with your insurance company's rebate check � by ripping it up.

That's right. If you're part of the considerable percentage of Americans who apparently think the insurance industry has been doing a dandy job of providing quality coverage at reasonable prices, then you'll undoubtedly see the $1.3 billion in rebates announced this week as an unfair burden on that industry.

Unfair burden, you say? Well, when HHS secretary Kathleen Sebelius called out Anthem Blue Cross for massive 39 percent premium hikes in 2010, she also pointed out that Anthem Blue Cross alone had taken in $2.7 billion in profits in one quarter in 2009. As blogger�Linda Bergthold�writes, the MLR's burden on large insurers�is "not insurmountable."

If you're in Texas � which had a higher percentage of uninsured residents than any other state in 2011 � �you might not feel so bad for insurers, especially since data showed that some residents faced premiums as high as $29,000 per person per year. Now, that's a burden, especially considering how the industry has been faring.

As this article points out:

By the end of 2009, roughly 2.7 million Americans lost their coverage, while CEOs of the top five firms each received as much as $24 million in compensation. It is a bitter pill to swallow.

Feel like Obamacare is playing Robin Hood by picking the pockets of a rich insurance industry in order to give cheap coverage to the poor? Also, are you convinced that Congressional opponents of the ACA have been protecting you? (or is it possible they were serving as hired muscle to protect the industry?)

Still hate Obamacare? Then here's what you do: RIP UP THE CHECK.

Come on. Surely, the modest rebate for folks in the individual market is a small price to pay to be able to clearly demonstrate solidarity against the health reform bill.

One more thing to consider: think about how much premiums would be rising this year without the MLR. If the medical loss ratio enforced by the Affordable Care Act had been in effect in 2010, the insurance industry would have had to shell out another $2 billion in rebates�to consumers for failing to meet the medical loss ratio target.

If you seriously believe that the industry has been doing everything it can to make premiums affordable (and you are not concerned by industry profits that have exploded over the past decade) � RIP UP YOUR CHECK. Send it to your member of Congress so he or she can use it to persuade Americans that it's time to back off.

Say it with me: "Rip up the check."

Disability, Disparities and the Health Care Law

As we commemorate National Minority Health Month, we can take the opportunity to not only highlight the health disparities experienced by racial and ethnic minorities and our progress toward health equity, but also the health disparities facing persons with disabilities. �For they, too, encounter considerable barriers to getting quality health care.

In fact, according to a report from last summer, �by every measure, persons with disabilities disproportionately and inequitably experience morbidity and mortality associated with unmet health care needs in every sphere. Minorities with disabilities are doubly burdened by their minority status.�� Access to providers, inadequate training and cultural competency among providers, and limited data and research in disability disparities are just some of the challenges they face.

Because of the Affordable Care Act, that�s changing.

It�s helping people like Sonia from Baltimore. Because of serious injuries from a car accident, Sonia feared she would have to spend the rest of her life in a nursing home, denied the ability to raise her young children and provide for her family. Instead, thanks to the law�s Money Follows the Person program, Sonia has been able to get help with home modifications and long-term attendant care from someone she trusts � critical help she needs to live at home. Now, she can support her family, play with her children, and be a part of her community.

Programs like these are so important, as is good research. Because of the law, HHS has developed new data collection standards on race, ethnicity, sex, primary language, and disability status for population health surveys, helping us to better identify disparities and target programs to reduce these disparities. And we�re helping propose new standards for medical diagnostic equipment, including mammography machines and exam tables, which can be difficult to use, especially for people with mobility disabilities.

The law has also provided coverage to over 55,000 uninsured Americans with chronic conditions and disabilities who previously would have been unable to obtain affordable health insurance. Insurance companies can no longer exclude kids with pre-existing conditions like asthma or diabetes from getting coverage, and by 2014, adults cannot be excluded because of pre-existing conditions either. We will also ensure that Affordable Insurance Exchanges and Medicaid enrollment and eligibility systems are accessible to people with disabilities.

Much remains to be done to better define and address disparities on the basis of disability. HHS is determined to continue making strides in achieving increased health equity through this vital work.

To learn more about what the new health care law does to help address disparities for persons with disabilities, view an updated fact sheet here.

CMS to develop eligibility tools for insurance exchanges

WASHINGTON – The Centers for Medicare and Medicaid Services plans to develop verification data and services to support coverage and eligibility infrastructure for health insurance exchanges and seeks industry information about applications that are available.

A solution that verifies eligibility for qualifying coverage in an employer-sponsored plan is part of the process for determining whether an individual qualifies for advance payment of the premium tax credit that is available to support the purchase of health plans through the exchanges.

[See also: Exchange deadline creeps closer]

CMS wants to identify authoritative data sources that can be used or adapted to meet the verification requirement and also how to develop new data sources that could fulfill that condition, according to an April 30 announcement for request for information in Federal Business Opportunities. Responses are due May 21.

Among solutions that the Health and Human Services Department has proposed in a rule describing health insurance exchanges is development of a database that contains authoritative data to assure employer-sponsored coverage.

The Patient Protection and Affordable Care Act did not require this data, so population of a potential database would be voluntary. And no data sources currently exist that contain comprehensive information about access to employer-sponsored coverage or the affordability and minimum value of such coverage, according to the notice.

[See also: Insurance exchange rule unveiled]

Under the health reform law, states must have operational capability of their online marketplace to compare and purchase health coverage by October 2013.

One example of how verification might work is that an exchange could use a database to check applicant attestations about access to employer-sponsored coverage. A business service request generated by the exchange would check private and public data sources through a CMS data services hub to confirm the accuracy of the data that was submitted. These data sources could include the state Directory of New Hires or state quarterly wage databases. 

CMS also seeks information about technology or business process applications that can verify the current income of individuals and households seeking insurance through the qualified health plans offered through the exchange, according to an April 23 request for information. The process is similar to that for verification for employer-sponsored coverage and the use of a CMS data services hub to confirm data. Responses are due May 14.

Exchanges must be able to determine also whether individuals are eligible to receive advance payments of the premium tax credit, cost-sharing reductions and exemptions from the individual responsibility requirement. Income levels are available from individual confirmation and data from federal, state and commercial sources.

Processes for eligibility and income verification need to be streamlined and coordinated across HHS, the exchanges, state Medicaid and Children’s Health Insurance Program agencies. Yet the information required from an applicant must be the minimally necessary to support eligibility and enrollment procedures across those programs.

[See also: Health insurance exchanges mired in political battle]

Do doctors have to be typists to get MU incentives?

WASHINGTON – There's a snag in the proposed meaningful use Stage 2 rule, and it concerns whether or not doctors need to be good at typing. Depending on how the final requirements for Stage 2 play out, they might have to be.

The HIT Policy Committee on Wednesday was divided over a measure in the Stage 2 rule that would allow licensed professionals or scribes to enter data into a patient’s electronic health record on behalf of a doctor.

The difficulty is this: If a doctor doesn’t enter the order, he or she will not be able to see the decision support built into the EHR system that appears at that time. Decision support is supposed to help with the prevention of medical errors and is, according to federal officials, one of the reasons for the EHR incentive program in the first place.

Most electronic health record systems only show decision support once, as the computerized physician order entry, or CPOE, is typed into a system, according to Paul Tang, MD, chief innovation and technology officer at the Palo Alto Medical Foundation and vice chair of the HIT Policy Committee. The problem is, most doctors do not type in their own orders. Nurses often enter medication orders or clerical persons type in hand written physicians’ orders, later to be “signed off on” – or approved on the computer – by the physician, often in groups of multiple orders at the end of the day.

 [See also: Stage 2 MU released at last.]

As the proposal stands now, the physician is required to use his or her personal log-on to open the record, and he or she is the person responsible for the electronic record. The physician is also responsible for approving any information entered by someone representing him or her in a clerical sense. If doctors want to see decision support, which includes warnings about dangerous drug interactions and other health preventative and safety warnings, then the doctor must be the one to type in the information.

Some members of the committee felt the rule was never intended to make doctors into typists. And even if they are good typists, they shouldn't be required to spend their time doing it. It prescribes too much for a doctors’ workflow, and is not what the proposal framers intended.

A serious discussion arose over the CPOE subject, scribes and decision support – labeled by Tang as “the single most important objective of the entire EHR incentive program.”

Last month, the committee discussed if there were other ways a clinician could have something recorded, then take responsibility for it. A physician might want to have a licensed professional enter the CPOE and then have someone else do the clerical task of entering the progress notes. Tang urged the committee to be more specific about who can enter non-CPOE entries.

Some members of the committee were in favor of scribes entering non-CPOEs, some were against, with the major consensus among the group that the physician is ultimately responsible for what is recorded.

Tang was in favor of scribes for some things. “This does not interfere with how ever people want to enter progress notes,” Tang said, “since we don’t have that same need for a feedback mechanism" in that case.

[See also: AHA says 'bar too high' for Stage 2.] 

“My opinion was to let it fall where it falls, and let them decide whether their physicians were less efficient or more efficient" at typing notes, said committee member Judith Faulkner, founder and CEO of Epic. "In some cases they might be, and in other cases they might not be.” 

Gayle Harrell, a Republican state representative from Florida, said the requirement needs to fall where the liability falls. “Liability is the issue,” she said. “It’s going to be difficult to determine who’s the typist.”

“There are two separate issues,” Tang offered. “The accountability for the entire EHR and the accessibility of the information.“

Neil Calman, MD, president and CEO of the Institute for Family Health felt decision support should not be compromised. If a physician doesn’t see the decision support, what good is it? “As long as the decision support appears at the time of authorization, the person who enters the order isn’t really that important,” he said. He added that it is common practice now for physicians to sign off on CPOEs that were typed in by other people.

“I strongly disagree with that,” said David Bates, MD, chief of research for the division of general and internal medicine and primary care at Brigham and Women’s Hospital. If physicians are to see the decision support, they have to see it when they type in the order, he said. “I’ve looked at a lot of different systems, all of them deliver decision support at the time that you’re actually entering the order. I’m fine with having scribes with other things,” he added.

There was some disagreement among the committee over whether or not current certified EHR systems allowed for decision support to appear again after the order is entered. Most of the physicians in the group said it was not possible. At least one said it was. Tang said to make Calman’s idea possible, it would probably require most physicians to have their EHR systems reprogrammed. Not a feasible idea, he said.

The EHR incentive program will not move forward if a doctor has to enter everything into a system, Calman warned. This would be loading doctors with too much work.

Tang also argued, “We want people to do the work at the top of their license,” implying that for doctors, this would be practicing medicine, not typing.

The committee was pressed for time, with only Wednesday’s meeting left to smooth out an entire host of recommendations due to the Centers for Medicare & Medicaid Services by May 7. Tang called for a vote on the CPOE recommendation, with three agreeing with what is written, allowing physicians to sign off on scribes entering non-CPOE data and licensed professionals entering CPOEs, without regard to when decision support may appear in the system.

Five members were in favor of revising the recommendation to require the EHR system to show decision support to every person who enters the data, including again to the physician when signing off. And, four abstained from voting.

“Clearly, we have a split vote," Tang said. “We will have to let CMS know about that.”

CMS is collecting public comments until May 7 on the proposed Stage 2 meaningful use rules. Agency officials say the final rule will be issued some time this summer. Physicians participating in the EHR incentive program would have to comply with Stage 2 rules as early as 2013, depending on when they complete Stage 1. Physicians who do not adopt EHRs by 2015 and use them according to the new rules, will face Medicare and Medicaid reimbursement penalties.