Beth Israel Deaconess Medical Center and 7 other pharmacies, labs and hospitals are partnering with Google to give patients the option of putting their personal electronic medical record on line. Beth Israel’s Chief Information Officer John Halamka says uploading individual files to “Google Health” will let patients access and add to their records if they see doctors, chiropractors or other providers outside BIDMC. Halamka says the records will be separate and protected from Google searches. Read more…

Having sat through celebrations, meetings and summits where Massachusetts has congratulated itself for creating the template for universal coverage, I would like to ask a core question: “Did we reform the system or just expand coverage opportunities?” This is important to clarify as we enter Chapter 58’s third year and we try to live up to the goal of covering all residents by addressing the remaining challenges.

According to Merriam-Webster Online:
Reform: to put or change into an improved form or condition; to amend or improve by change of form or removal of faults or abuses.
Expand: to open up; to increase the extent, number, volume, or scope of.

My area of expertise is eligibility and enrollment. From this perspective, I would suggest that what we have created is primarily a beneficial expansion of health coverage options, an “opening up” as opposed to an “improved or changed form.” Read more…

The process of implementing Chapter 58 has been full of surprises. For me, one of the biggest is that April 15 has come and gone with so little public outcry about the individual mandate (IM). The IM is the most radical feature of the state’s health reform law. (Before any of you readers gang up on me, remember that “radical” means fundamental, extreme or drastic—it carries no value judgment about good or bad). No state has ever imposed such a broad requirement on its residents to purchase health insurance, nor levied state tax penalties on people who don’t comply. We’ll understand more about how this provision of the law is working when the state Department of Revenue (DoR) releases information from the 2007 state tax filings, which should be soon. I, for one, am really curious to see what the data show.

We will all need to interpret the DoR data with caution. Read more…

Policy-makers and opinion leaders in Massachusetts understandably are focused these days on activity at the Statehouse. Lawmakers are making critical decisions about state expenditures for the remainder of the current fiscal year as well as the next. These decisions have enormous implications for MassHealth, the state’s Medicaid program. MassHealth pays for services for more than 1 million Bay State residents. Its expenditures account for about 20 percent of total health care spending in Massachusetts. And its funding is critical to safety-net providers, such as health clinics and community hospitals, who provide services to some of the most vulnerable among us.

Medicaid also is central to the success of the health reform law passed two years ago. Chapter 58 expanded Medicaid coverage and provided for increased outreach to eligible populations. Since July of 2006, more than 100,000 additional residents of Massachusetts have been enrolled in MassHealth. Medicaid also helps finance the premium subsidies that make coverage affordable to low income Massachusetts residents through Commonwealth Care, which now covers nearly 177,000 people.

Attention to the state legislative process from Medicaid-watchers is therefore well-placed, but there is another front we should be watching: Washington D.C. Read more…

THE STATE LARGEST HEALTH INSURERS ARE REPORTING MIXED RESULTS FOR THE FIRST QUARTER. BLUE CROSS HAD A NET LOSS OF 2.2 MILLION DOLLARS FROM HIGH FLU AND OTHER SEASONAL MEDICAL COSTS AS WELL AS THE LOSS OF MEMBERS DURING CORPORATE MERGERS. HARVARD PILGRIM, TUFTS AND FALLON ALL POSTED NET GAINS. ALL FOUR INSURERS USED INVESTMENT INCOME TO OFFSET OPERATING LOSSES.

It’s a health policy truism: one person’s waste is another person’s paycheck. And it’s vividly playing out in the debate over proposed ban on drug and device maker gifts to physicians in Senate President Therese Murray’s cost control legislation. It’s not just the lobbyists and the drug reps (we estimate 2,000 to 3,000 just in Massachusetts), it’s the pharmaceutical “bling” makers and distributors, it’s the caterers, it’s friends and relatives of the above. A veritable industry devoted to the subtle and not-so-subtle seduction of physicians. All of them contacting their legislators to oppose the ban.

So the proposed gift ban poses an important and timely question – does Massachusetts possess the political will to address wasteful rising costs when a well-heeled lobby protests? If we can’t address this blatant waste, what waste can we address? Read more…

Here’s the premise:

The debate about health care tends to be informed by three notions about health insurance:

1) The profits of private insurers are so big that cutting them out would meaningfully lower costs.

2) Private insurance clearly costs more than a government-run system such as Medicare.

3) Mergers that have created a small number of huge and powerful insurers increase health care costs.

None of these is true(read on).

THESE 47 PROVIDERS HAVE AGREED TO SERVE 2-3 YEARS AT A COMMUNITY HEALTH CENTER IN MASSACHUSETTS…AND IN EXCHANGE…ERASE UP TO 75-THOUSAND DOLLARS IN STUDENT DEBT. THE PROGRAM WAS CREATED TO HELP MAKE SURE THERE ARE ENOUGH DOCTORS FOR HUNDREDS OF THOUSANDS OF NEWLY INSURED RESIDENTS. JOAN PERNICE WITH THE MASSACHUSETTS LEAGUE OF COMMUNITY HEALTH CENTERS SAYS LOAN FORGIVENESS IS A KEY RECRUITING INCENTIVE.

This loan repayment program can almost be a tipping point of really being that one thing that helps people make up their minds of working in community health centers.

TAKE JOSEPH PEPPE, THE ASSOCIATE MEDICAL DIRECTOR AT SOUTH BOSTON COMMUNITY HEALTH CENTER. PEPPE SAYS THE LOAN ASSISTANCE MAKES IT EASIER FOR HIM TO IGNORE HIGHER PAYING JOBS.

There are other sites in Massachusetts and outside Massachusetts where physician reimbursement is higher and that would help with repaying loans whereas instead, the loan repayment program allows me to continue practicing where I enjoy practicing and want to continue practicing.

MOST OF THE FUNDING FOR THE PROGRAM COMES FROM BANK OF AMERICA AND THE STATE.

John Halamka, the Chief Information Officer at Beth Israel Deaconess Medical Center, says hackers attempt to break into the hospital’s networks every 7 seconds. He has four people working fulltime to fend off attacks, many of which Halamka says are from East Cambridge (MIT) and Eastern Europe. Harvard hospital system =s big trophy. Halamka wrote about this on his blog last October and has a list of 10 recommendations for improved security. I post the link for anyone who didn’t see it, and is thinking about the security of on-line (medical) records.

Today, I do her pap smear, and get her a mammogram. Another day we work through her insomnia. Yet another day we figure out how to fix a knee that hurts.

I sell primary care. I’m proud of my work – it’s the only medical service that improves life expectancy, that reduces the cancer death rate, the heart disease death rate, and increases life expectancy. It’s the only medical service that meets people where they are, as they are, and tries to listen.

I don’t sell health insurance. Health insurance costs between $500 and $1000 per person per year for the paperwork alone. Primary care, on the other hand, costs $150 per person per year.

Our political candidates believe that we can create access to health care for all Americans by working with, or remodeling, our health insurance marketplace. But 60 years of health insurance, uncontrollable costs, expenditures that now comprise almost 17 percent of the Gross Domestic Product – more by far than any country in the industrialized world– 47 million uninsured, and population health indicators that leave us ranked between 25th and 75th in the world, all suggest that our problem is not in fixing insurance; indeed, our problem may be with our failed attempt build an insurance system before we built a health care system. Read more…