Healthcare Policy & Reform

The week in Government HIT: May 7, 2010


- Monday, May 3: The HHS Office of Civil Rights releases a request for public comment on their effort to expand patient notification rights in the event of a protected health information (PHI) disclosure. This contemplative commenter sees this effort as an important balance to the HITECH project, insofar as it increases patient confidence in electronic health information–and sometimes shows when this confidence is unwarranted. Now who could be against that? Well, anyways there are some parts that might be operationally problematic, but we’ll point those out as appropriate.

- Tuesday, May 4: The Beacon Communities are awarded! The final shoe drops in HITECH grants with the award of $220 million to 15 communities that are to be the pillars of excellence in healthcare IT. The list of awardees is a sample platter of healthcare stakeholders. Some of the awardees are already ‘beacon’ communities (Mayo, Geisinger, IHIE, Intermountain), but ONC made some inspired choices as well. Love the Piedmont project, or at least as much as I can tell from a paragraph. RIQI’s project with Blackstone Community Health Centers tackles my favorite topic: PCMH. And it’s hard not to get teary-eyed thinking about the good that the Louisiana Public Health Institute will do in empowering patients with health information. Among them all, here are the big topics that stood out to me: sustainable health information exchange (HIE), diabetes care management, telemedicine, patient engagement and personal health records. Who knows what brilliant, bountiful brainstorms of beneficence come out of these guys, but it’s been fun horse race to see the field whittled down from 190 to 15! (Though probably not as fun for the 175 stallions that weren’t selected.)

- Tuesday, May 4: Physicians Reluctant to Adopt EHRs: It appears some doctors are still not convinced about the benefits of electronic health records and are willing to accept a decrease in Medicare reimbursement. There has been pushback on the meaningful use standards with many groups asking to see the program extended to 2017. However, in Massachusetts the drive to educate physicians about the benefits of EHRs continued last week at a conference hosted by Governor Deval Patrick.

- Wednesday, May 5: Four more state Medicaid agencies get matching funds for EHR incentives for CHCs and pediatricians: Missouri, Washington, New Mexico, and Oregon. As this cunning correspondent pointed out a month ago, each of these Medicaid agencies will dramatically affect the appropriate distribution of incentive funds in their state. Set the bar too low, and patients don’t benefit from the technology; set the bar too high, and deserving groups won’t seek to improve because of administrative overhead and reporting requirements. Botch the reporting or standards setting entirely, and they’ll end up with a lot of wasted money. Our hats are off to them in hopes that they are successful.

Spotlight on: Health Reform – The California Perspective

Many of the health reform provisions – such as the creation of health insurance exchanges and the requirement that most U.S. residents purchase health insurance – won’t take effect for several years. However, there is quite a bit that goes into effect this year that likely will have an immediate impact in California. Here’s a rundown of the upcoming changes and how they affect the California marketplace.

One of the largest challenges California faces, along with many other states, is the expansion of the Medicaid program. The health and human services system in California is overwhelming. It takes four immense computer systems to process claims, determine eligibility, track beneficiaries and distribute billions of dollars in benefits. Try this on for scale: about one-third of the state’s human services caseload is concentrated in Los Angeles County. That one county provides services to 2.2 million people, at a cost of about $3 billion a year. But the computer system that crunches the numbers for that weighty system is nearing the end of its useful life, state officials say. That’s especially important now with California preparing to increase eligibility for Medi-Cal as called for in the federal health reform law. This article goes into more detail and estimates the cost of rebuilding the system at $530 million.