Late last week, Iowa’s Democratic Representatives overcame steep political odds in the House and struck a deal with leadership to add language to the health reform bill seeking to address the Medicare geographic variation issue. This deal, spearheaded by Iowa Congressman Bruce Braley, appears to have broken the indefinite stalemate in the Energy and Commerce Committee that until then had prevented the legislation from moving forward. Iowa Congressman Dave Loebsack also joined the conversation with leadership and defended Braley’s proposal threatening to withhold his vote on the legislation unless this issue was addressed. This comes at a critical juncture in the health care reform debate, and IHA supports and applauds the efforts of Iowa’s House Democrats in addressing the long-standing problem of Medicare geographic disparity.
Specifically the proposal instructs the Institute of Medicine (IOM) to conduct two studies. For the first study, IOM will have one year to evaluate geographic adjustment factors in the Medicare payment formulas including the wage index and the geographic practice cost index to determine whether the data and assumptions for the adjustments are accurate or based on flawed data. The Secretary of Health and Human Services (HHS) must then implement the findings from the study automatically without Congressional review. The legislation would establish funding available for FYs 2012 and 2013 to increase payment rates in regions where rates are low and hold harmless areas where payments have been historically inflated. The hold harmless protection expires after FY 2013 and any adjustments due to the IOM recommendations will become budget neutral.
The legislation also instructs IOM to complete a study of geographic variation in health care spending and promoting high value health care, with specific instructions to consider adopting a value index. IOM will have two years to make recommendations to HHS on how to promote the efficient delivery of high quality, evidence-based, patient-centered care. HHS will then submit a report to Congress on implementing a plan to revise Medicare payment systems based on the finding from the above IOM study, which will be implemented unless Congress votes against it by February 28, 2012.
IHA also continues to work on the issue of value-based purchasing with a Medicare cost-per-beneficiary component with the Senate Finance Committee where Senator Chuck Grassley has been a leading voice on the issue during the bi-partisan negotiations. The Senate approach would be in accord with IHA’s long standing position in support of a value-based purchasing program that not only measures quality but also resource utilization and efficiency.
While health reform is far from final, Iowa’s congressional delegation continues to stand up for Iowa hospitals and health care providers in the debate and deserve recognition for their efforts when they return home for the upcoming August recess.
Recent momentum in the ongoing health care reform debate in Congress was brought to an abrupt halt last week as conservative “Blue Dog” Democrats on the House Energy and Commerce Committee (the last of the three committees needed to approve the legislation in the House), refused to sign off on the bill, thereby halting progress indefinitely. However, late last week reports indicated a compromise may have been reached with the committee chair, but the deal is not sitting well with the health care industry, including IHA.
The Blue Dogs, supported by budget figures from the Congressional Budget Office, shared concerns that that House bill doesn’t go far enough to rein in Medicare spending over time and runs the potential of increasing the national deficit by $250 billion over 10 years. Their solution is to transfer the authority of setting Medicare payment rates from Congress to the executive branch through an “Independent Medicare Advisory Commission” that, along with the president, would have unprecedented power to set annual payment rates for doctors, hospitals and other health care providers.
Further, once the commission announces Medicare payment rate cuts (or increases), Congress would then have 30 days for both chambers to pass a “joint resolution of disapproval,” which would be subject to a presidential veto that would require a difficult-to-achieve two-thirds majority “override” vote to undo the commission’s recommendations.
This is an unacceptable proposal that is opposed by IHA. Not only does this strip power from Congress, but it also removes hospitals and providers from the debate, as a presidentially appointed commission is less likely to listen to input from industry leaders.
IHA has been in contact with Congressman Bruce Braley, who serves on the House Energy and Commerce Committee, to express opposition to this measure. At this time, Braley, who is not a Blue Dog, has not commented on his support or opposition to this compromise.
Meanwhile, the Senate has also ground its efforts to a near halt as Democratic leaders announced this week that they have abandoned plans for a vote on health care reform before Congress’ August recess. This news comes one day after President Obama’s fourth prime-time news conference on the issue of health care reform. Senate Majority Leader Harry Reid (D-NV), held a news conference echoing many legislators from both sides of the aisle, saying, “It’s better to have a product based on quality and thoughtfulness rather than try to jam something through.”
The Senate Finance Committee has yet to release its legislation and is still working to put together a comprehensive, bipartisan proposal.
IHA continues to work with Iowa’s Congressional Delegation on the many issues that remain outstanding in the health care reform debate, including the need to include an efficiency measure based on cost in the proposed value-based purchasing program in Medicare.
The days of health care providers looking up information in reference books may soon be a thing of the past thanks to the rising popularity of smartphone applications.
In April 2009, Manhattan Research stated that 64% of physicians are currently using smartphones and the number of physicians using iPhones more than doubled in the last year.
Smartphones apps not all fun and games; physicians finding real uses
HealthLeaders Media recently interviewed Dr. Michelle Eads, a primary care physician who routinely reaches for her smartphone before writing a prescription. Dr. Eads relies on Epocrates, a comprehensive drug and disease reference application, to quickly decide what the safest medication options are by looking up drug interactions, side effect profiles, adverse reactions and contraindications.
In addition to the numerous applications available for health care professionals, companies like Think Safe, an Iowa-based company, offers apps for the general public that will verbally coach users through assisting with severe allergic reactions or emergencies requiring CPR.
Here’s a look at some of the more popular medical applications available:
- Epocrates: A drug reference containing information on more than 3,300 drugs, including dosing, adverse reactions, pricing, and pictures.
- Skyscape Medical Resources: Comprehensive drug information, clinical information, medical calculator and up-to-the-minute medical alerts by specialty
- EyeChart: A mobile Snellen eye chart that can provide useful screens for rough visual acuity.
- MedCalc: A collection of clinical calculators including Body Mass Index (BMI), I.V. drip rates, ABG interpretation and pregnancy wheel.
- Speed Bones Lite: Free version of Speed Bones MD that tests your speed and challenges your memory of the human anatomy.
- Taber’s Medical Dictionary: Includes more than 60,000 terms, 1,000 photos and 600 Patient Care Statements.
- Davis’s Drug Guide for Nurses: Includes nearly 5,000 trade and generic drugs, the most common natural and herbal products, as well as monographs of indications, side effects and interactions.
- Eponyms (for students): Short descriptions of medical eponyms, such as Rovsing’s sign and Virchow’s node.
- uHear: A mobile hearing loss screening test that lets you test hearing to determine if it is in normal range.
- Pocket First Aid & CPR: The latest up-to-date information from the American Heart Association on first aid and CPR procedures. Also allows user to enter personal medical information including allergies, medications and emergency contacts.
- Police Scanner: For people who love to listen in to police scanner frequencies. Allows users to select from nearby streams or from feeds around the world. Great for “On Call” volunteer fire fighters, news crews, and emergency responders.
What kind of phone/mobile device are you using? Are you using any apps on your phone to assist you in your work? What are your favorite apps?
[Photo via johanl on Flickr]
The July 22 edition of the Des Moines Register featured a guest column from IHA president and CEO Kirk Norris titled, “Iowans’ health care in jeopardy if reform means reallocation.”
In his column, Norris outlined the key issues Congress should consider while working to reform the nation’s health care system.
The main theme of the article urges Congress to develop a payment method that incents providers to deliver efficient care (efficiency = high quality and low cost) instead of being paid just on quality alone.
This is a particularly important concept for states like Iowa, because we have one of the lowest levels of Medicare spending per beneficiary nationwide. This fact has been highlighted on the IHA blog before, citing statistics from the Dartmouth Atlas of Health Care measuring health care value.
However, the current debate only holds the potential for further disenfranchisement of high-performing states (like Iowa, ranked second in the nation in quality and cost) with changes to the system that seek to simply reallocate current resources rather than change the outdated and inefficient payment methods that would actually produce the reform the system needs.
Please stop by the Des Moines Register Web site to read the full article and feel free to share your comments, either there or here on the IHA blog (below).
There are several new additions to IHA’s list of Iowa hospitals using social media.
- Mercy Medical Center – Sioux City is on Twitter and Facebook
- Humboldt Hospital has a blog
- Pella Regional Health Center is on Twitter
- Crawford County Memorial Hospital is on Twitter
- Great River Medical Center is on Twitter
- Story County Medical Center is on Twitter
This latest wave brings a flurry of tweets, increasing our totals to 13 hospitals in Iowa using Twitter.
How do you see hospitals being able to use social media?
Are these hospitals doing things right? Could they be doing things better? If your hospital was on Twitter, Facebook or somewhere else, what would you expect of them?
IHA is interested in hearing your thoughts and I will continue updating the list of Iowa hospitals using social media to keep everyone informed.