Twenty-ten is the year for mergers and acquisitions in the healthcare delivery marketplace? A year ago, with President Obama’s massive push for government-enabled reform, a scenario such as this would have been unthinkable in polite (poltical) company. But recent developments in the drive toward reform are really anything but.

Although reform is on shaky ground, major health plans and other third parties are not exactly rushing toward consolidation. A wait-and-see attitude is the gameplan for now. But don’t be surprised to see the market for Medicaid managed care benefit from the weakened stance on reform in Washington. | LINK

Obama is currently changing the focus of  his administration’s effort at domestic economic fixes from healthcare to jobs creation.  But he hasn’t completely abandoned healthcare lately — in spite of the recent media coverage hinting of the president’s pressuring Nancy Pelosi to just go with the Senate version pronto.

At an effort to keep health reform from the jaws of death, Obama has invited GOP leaders to discuss possible bipartisan compromises in a meeting slated for the end of this month.

Asked if he was willing to start from square one, the president said he wants “to look at the Republican ideas that are out there. And I want to be very specific. ‘How do you guys want to lower costs? How do you guys intend to reform the insurance markets so people with preexisting conditions, for example, can get health care?’”

Haven’t we been here before? Over a year into his presidency and his dreams of reform passage still the stuff of pipes — patients, providers, and pundits are probably growing as weary as the GOP (now that filibuster is not a possibility) watching this fight play on.

A White House statement Sunday said Obama repeatedly has made it clear “that he’s adamant about passing comprehensive reform similar to the bills passed by the House and the Senate.”

“He hopes to have Republican support in doing so, but he is going to move forward on health reform,” the statement said.

Obama hopes? For all of those wondering just how flawed the Democrats’ bipartisan strategy has been up to this point with respect to reform, it is unfortunately totally being laid bare now. The battle for reform on Obama’s terms is rapidly slipping away. | LINK

A couple of weeks ago, I interviewed the CEO of the EHR/PHR tech company MediConnect, Amy Rees Anderson. What follows is the second half of that interview here on Doctor Pundit.

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DP: How important is portability of the health record for patients beginning to benefit from EHR adoption?

Ms. Anderson: The cheapest way to facilitate the portability of the records is to have the doctors adopt electronic medical records at point of care. Once this occurs the ability to retrieve and transfer records will become substantially more affordable. Again, I don’t think we will see this adoption for doctors really start to boom until we incent the current providers to do so. I do, however, believe that the rising generation of physicians who grew up with their handhelds and tablet PCs will come right out of school using these systems already. But it’s the physicians who have been practicing for years that we need to incent to switch over. Without electronic health records we can still retrieve and digitize the paper records like MediConnect has been doing since 1996, it just comes at a higher cost than if we dealt with all electronic records.

DP: Do you see any immediate barriers to adoption with respect to hospitals, vendor interface, or broadband availability in resource-poorer regions of the country?

Ms. Anderson: I don’t think broadband availability is the barrier to adoption today. The majority of records are stored in offices in the metropolitan areas of the country where the highest numbers of people live anyway, which has ample availability for high speed. In the smaller areas, where the Internet is slower, the doctors can keep records on a local server that can connect and upload to secure online storage in batch mode, so it won’t prohibit them from the changeover to electronic records. With regard to vendors, I think it’s important to let doctors choose whatever electronic records software works best for them in their own practice. Trying to force everyone on to one system is just not practical. That said, every system should allow for the transmitting secure health data to other systems as requested by the patient controlling that data.

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I’ve mentioned President Obama’s pay-as-you-go (or, “paygo”) ideal as a means of dealing with deficit spending wrought by his current 2011 budget proposal. Concerning healthcare, Medicare cuts would be exempted under this paygo provision. Buried within the monstrous budget text is the adjustment totaling $371 billion to fend off Medicare cuts to physicians over the next 10 years.

For much of the past decade, physician providers of Medicare-covered services have been granted reprieve after reprieve from threatened cuts to the program. These yearly proposed cuts to Medicare are largely based upon the sustainable growth rate (SGR) — an economic indicator. Of course, these iterations without enactions have only added to the overall national debt. With Obama’s 2011 budgetary blueprint, the adjustment means that come March 1, physicians who see Medicare patients will be granted a temporary fix once again — as the Medicare growth rate is effectively zero percent for the next 10 years. Should Congress just vote to scrap the SGR formula upon which Medicare cuts and their rates are based, saving massive debt increases over that time?

According to the AMA, legislation to do just that would solve everything — advocating less costly alternatives to formulating a permanent fix to Medicare deficit spending as opposed to Obama’s temporary decade-long adjustments. What does the White House say? At this moment, it hasn’t taken an opinion on an SGR repeal effort. | LINK

The increase is primarily for health programs in poor countries that will build on U.S.-funded efforts to combat AIDS. President Barack Obama’s budget boosts global health initiatives by almost 10 percent — expanding child and maternal health programs that coincide with AIDS relief programs in the world’s poorest countries.

The new global health initiative reiterated the administration’s pledge to put more than four million people on HIV/AIDS drug therapy and prevent more than 12 million new HIV infections by 2014.

AIDS/HIV continues to be a scourge worldwide, to say nothing of its prevalence here in the United States, as well as here in Minnesota — whose increases in incidence and prevalence should not only spur new efforts at education, but also at healthcare delivery with respect to this still-fatal virus. | LINK

All it took was an inch — as the GOP is going the whole mile, and then some. I’m talking about the stalemate in getting Obama’s reform bill passed. The election of Scott Brown to fill the seat once held by the legendary health reform stalwart Ted Kennedy seems to be only the beginning of an effort by the GOP to take over the parameters of what “reform” really means at this point.

The WaPo has an interesting analysis into the Democrats’ missteps leading to where the party finds itself today: a wounded warrior with very little to show in the way of valor in upholding Obama’s original plans for an overhaul.

Looking back, Obama and his congressional allies failed to appreciate the depth of frustration with Washington – people’s desire for health care legislation that would respond to their anxieties, not the clamor of interest groups.

There’s more. Some GOP lawmakers are upping the anti-reform rhetoric with fiesty language meant to energize its base and incite debate for their benefit. Invoking states’ rights arguments, a VA congressman calls reform measures at the hands of Democrats “mobster mandates”, and such issues “cross the line” as far as he’s concerned.

Del. Robert G. Marshall (R-13th District) has filed the “Virginia Health Care Freedom Act” (HB 10), which would “protect an individual’s right and power to participate or decline to participate in a health care system or plan,” according to a summary of the bill.

Mobsters and missteps. February is getting off to a rollicking start for the party that was supposed to have had a bill on Obama’s desk by now.

You just have to hand it to Minnesota and its spirit of rugged self-determination. Its citizen individualism and desire to pioneer are just a couple of the qualities that are part of the state’s storied history as innovator and trendsetter. The concept of managed care as a healthcare delivery ideal had some of its roots in Minnesota, a concept going back over 35 years. Designed as a way to create a balance between providers and payments for services rendered, it has evolved — for better or worse — into a system upon which today’s healthcare marketplace has codified current business practices. That is, the very dynamic which has given the current President of the United States such a strong (though somewhat misguided) desire to overhaul the way healthcare is delivered in this country.

Pharma, Insurance, and the physician are the core triptych at which so much in the debate to reform healthcare is directed. Many primary care physicians feel as though they are at the epicenter of this reform morass, and many are left feeling dismayed over why they chose medicine as a profession at all. For many family docs, for example, navigating the complexities of day-to-day practice; feeling the pressure of seeing enough patients to justify employment in many manage care systems; and dealing with Insurance and public payers in order to simply get paid are essentially too much for them to deal with. Attrition from the profession usually results.

Imagine the self-determination of one Minnesota family physician — an employee of a primary care group in the Twin Cities for decades — when he simply could not “take it any more”. With actions that can at once be described as both narcissistic and noble, this doc decided to go it alone and get Insurance out of the mix altogether. Armed with $80 000 and a desire to accept only cash, he’s jumping into uncharted territory in 21st century healthcare delivery and going back to the pre-managed care days of Dr. Marcus Welby — and he’s doing it in one of the most heavily-penetrated managed care states in the country. The spirit of Minnesota innovation shines again, at least for one physician. | LINK

A nationwide clinical trial is underway to determine if a specialized drink is able to improve the neurocognitive deficits seen in Alzheimer dementia (AD). The tested concoction is being evaluated for its ability to provide improvement in the clinical domain of verbal recall. The trial is based upon a European study done in which 225 AD patients were randomized to take the nutritive drink or a placebo. Results were apparently encouraging^[1] enough to U.S. researchers to enroll patients at 40 sites across the U.S. in a double-blinded study. Should be interesting.

I guess you could call it a kind of Boost for dementia.

1. In that study, 225 patients with mild Alzheimer’s were divided into two groups. Some drank Souvenaid and the others sipped a non-medical drink every day for 12 weeks. Researchers found that the patients who drank Souvenaid improved in a delayed verbal recall task. [↩]

You know about the movie Avatar? Of course you do. It’s the new James Cameron movie which recently beat out that other Cameron flick Titanic to become the biggest worldwide and, shortly, domestic grossing film of all time — taking in a whopping $1.8B to date (almost $600M in the U.S.).

Now imagine the next Cameron vehicle surpassing Avatar by 33X. That’s the amount of public and private healthcare spending lost to fraud each year, according to remarks made by Atty. Gen. Eric Holder. Obama’s top lawyer was at the NIH yesterday pushing for a cabinet level commission designed to administer enforcements against healthcare fraud in both public and private sectors.

Will Congress listen? Just earlier this week, during his first SOTU address, Obama pledged a government spending freeze for three years — asking the legislature to pass a “pay as you go law” — requiring lawmakers to offset the cost incurred by the current tax cuts or incurred expenses due to programs like Medicare (which would be exempt from this law) with the increase in taxes. In essence, Obama would be keeping a ledger of the average budgetary effects of all legislation affecting mandatory spending.

According to Holder, public and private healthcare sectors need to embrace this new reality and the spending it will take to make it happen.

[O]ur ability to protect taxpayer dollars, to ensure the viability of our government health care programs, and to strengthen our national health care system depends on our ability to expand the discussion beyond the federal government…

LINK

Pennsylvania’s Corrections Department is getting creative in the healthcare delivery to its aging prison population. With funding courtesy a grant from the National Institute of Nursing Research, the state will be bringing together the appropriate caregiving provider contingent to study the cheapest and most effective ways to deliver end of life (EOL) care. This pro-active move will likely be a point of reference as state budgets come under increasing pressure to provide this level of service to this patient population in the unique ”perfect storm” of declining state budgets devoted to healthcare delivery; exponential growth of geriatric populations/units in correctional facilities; and competition for federal healthcare dollars as the result of the Obama reform package (whenever that occurs).

The project will develop an intervention toolkit for use by staff at any prison in the country. [..] Prison workers, including health care professionals, chaplains, prison society volunteers and corrections officers, will provide information on current limitations, strengths, existing perceptions of end-of-life care among prison stakeholders and areas of care that bear improvement. Using the data collected, researchers will create a set of educational strategies for use by prison staff that they can tailor to fit individual prison’s needs.

The devotion of grant money to fund this type of research is appealing and compelling on many fronts — not the least of which is a shared national discourse which is sure to follow on such unique EOL care initiatives. | LINK

Higher copays mean a higher incidence of unnecessary acute care visits, thereby placing elderly patients at higher risk for significant medical problems if not caught earlier. This, according to a study just published in the NEJM. This trial sheds light on a phenomenon not adequately studied until now because of numerically inadequate elderly subjects for study and the absence of reliable Medicare claims data.

Patients affected were principally enrolled in Medicare Advantage (MA) plans whose premium copays increased.  They were compared to patient cohorts whose plans did not increase copay amounts for a 5 year period (2001-2006). The shifting of the cost of care burden to the patient resulted in the findings of almost 20 fewer annual outpatient visits per 100 enrollees in the year after the rise in copayments and 13 more annual inpatient days per 100 enrollees of MA.

Although study limitations were quite notable for the lack of randomization among specific medical diagnoses (non-randomized controlled mechanism); the use of primary care versus specialty care measurements; and the lack of the inclusion of the measurements of cost-shifting on future hospital visits — the basic take-home message is the same: increased out-of-pocket healthcare costs for ambulatory (office) visits for elderly patients mean decreased secondary prevention of adverse medical consequences and higher healthcare costs overall, owing to increased use of hospital services. | LINK

A hospital rating company reports that regional and community medical centers do a much better job at preventing hospital-acquired infections and complications that can result in fatalities. Preventable complications or hospital-acquired infections kill 100,000 people each year. The rigor many tertiary care centers foster in the world of academic medicine may be the culprit, as the rather mundane task of creating and maintaining systems of checks and balances often is perceived to be a less than glamorous activity. The administratively rote nature of providing acute hospital-based algorithms for the safety and preventable deaths of all hospital inpatients is just not as sexy as trumpeting the singular life saved by treating that one rare and exotic illness. | PDF LINK

Times are tough in all service industries, as well as in healthcare delivery. In many health systems, the acute hospital is not only a prime revenue-generator, it also is a service aggregate which can provide a multitude of care environments, within which specialty care and primary care can thrive.

So, imagine the public despondency among one financially troubled parochial hospital in NYC in response to a large city system’s plans to buy a revenue-hemorrhaging Catholic hospital in the city’s fabled Greenwich Village and turn it into an ambulatory care center. St. Vincent’s Hospital, home to the treatment of many of the city’s HIV positive and mentally ill indigent, has struggled to remain fiscally viable after emerging from bankruptcy only a few years ago.

One-hundred sixty years of charity care and national prominence the hospital earned in the months and years after 9/11 could be just a memory for New York’s last Catholic acute hospital if its buy-out is realized. | LINK