It had all the trappings of a political football; a blue state’s extremely unpopular Republican governor — looking toward a possible presidential run a year after his term ends — used his partisan hardline to threaten veto of one of the most well-funded social programs for healthcare delivery to the state’s working impoverished, all the while setting the stage for a political attack on his character for all of the nation to see at the hands of the opposing party. The apparent newfound conciliatory stance taken by Minnesota governor and 2012 prez hopeful Tim Pawlenty concerning the threatened veto of GAMC headed this scenario at the pass, however, as the healthcare delivery safety net for thousands of the state’s working poor got a last-minute reprieve to continue being funded, albeit scaled back. Of course the negative PR surrounding a pending lawsuit by three beneficiaries of the program didn’t make eating crow any easier for the chief executive.

Though funding for the program was supposed to end on April Fools Day, the brokered change in funding commitment means that service providers will see less in reimbursements. Also,

[u]nder the agreement, hospitals will receive $71 million from the state’s general fund for the year starting July 1 and $131 million the following year. About 12 to 15 hospitals likely can start serving patients in the new program on June 1. For others not yet ready, $20 million will be set aside to pay for uncompensated care for six months.

The key is in acute care — often the first and only mode by which this underserved patient population will continue to receive care. With a decrease in monies to provide it — even with a grace period of sorts for charity care — the level of participation of acute hospitals is emblematic of both ongoing problems with funding (providing care) and simply surviving as they continue to operate in a program whose demand will only increase until reform is achieved on the national stage. | LINK

Physicians — especially those of the primary care type — are spared the potential problems that come with cuts in Medicare payments. At least for another month. President Obama has delayed the anticipated 21% cut in reimbursements while Congress has to take the matter up yet again.

Sen. Jim Bunning (R-KY) created a legislative frenzy last week when he placed a procedural hold on the bill that would have extended health care benefits to the unemployed for an additional length of time. That measure would have also allowed taxpayer subsidies to be used for premiums. Bunning relinquished his standoff yesterday, allowing this extension on cuts in payments to be avoided for another 30 days.

Polling, as a result, shows just how far cuts in Medicare payments to providers and provider organizations will go in threatening care delivery to a huge segment of the chronic care patient population — the same demographic responsible for the heaviest utilization of pharma, primary care, and acute care. Approximately two-thirds of primary care physicians polled by Medscape said they would cease to care for Medicare beneficiaries as a result of the cut.

An extension only holds off the inevitable, and although Senate Democrats are looking for ways to delay cuts further, there has to be a day of reckoning. That could come October 1, if senate legislators work to pass another bill [PDF] and try to reverse the SGR formula [PDF], which is responsible to establishing pay cut schedules in Medicare provider reimbursements.

With reform, the current band-aid strategy the Obama administration is using continues on its sloppy course.

President Obama’s version of the reform bill (the one he is personally proposing and defending, come later this week) is getting a shot in the arm. Hoping to stoke public animus against the recent massively outrageous insurance premium hikes by Blue Cross in California and in other states, Obama will once again renew the call for a bill mostly on his terms.

Coming nearly a year after he put the push toward reform into overdrive, Obama will include the new provision that will allow the government (HHS) and states the power to bar or limit such increases — even demanding rebates for consumers of healthcare in such an environment. All of this is in anticipation for the bipartisan summit with senate Republican and Democratic leaders at which Obama will add previous provisions which include barring claims denials for pre-existing conditions, and a tax on HDHP (Cadillac plans).

Republicans are standing fast on their admonition to force Obama essentially to start from scratch, with a nod toward a more tepid bill with less obvious government funding. The showdown takes place later this week and will be televised. | LINK

UPDATE: The WH has posted Obama’s proposal summary. | LINK | At initial look, the president’s plan does not appear to repeal the antitrust exemption. | LINK [PDF] | Also, without public option language in the proposed bill (as expected), what’s next for each side? The heavily hyped bipartisan summit awaits this week. But what about afterwards? Assuming the Republicans stick to their guns, obliterating the WH’s strategy of forcing them to defend their antipathy toward the bill on fiscal grounds, will the party extend the drive for nay votes toward mditerms? Since the Dems are down by at least three votes, this could be likely. Perhaps, a protracted fight among both sides will be good for the bill’s ultimate passage on (mostly) Obama’s terms —  then, and only then, will the true transparency of the proposed bill’s language come to light as Americans may use November as a referendum on health reform.

Minnesota Governor Tim Pawlenty is making good on his executive powers to slash the state’s budgetary expenditures the only way he knows how — via veto. Almost on cue, the state’s chief executive promised to do so in a letter [PDF], explaining that Minnesota simply cannot afford the almost $300M pricetag for a stopgap program designed to be a healthcare safety net to its working poor, the chemically dependent, the mentally ill, and homeless.^[1]

Amid dwindling hopes of a Medicaid expansion of funds, Democratic legislators passed the measure by large margins in both House and Senate to extend the state’s GAMC payer program for another 16 weeks. The governor’s veto underscores his support for the alternative — enrollment of GAMC beneficiaries into another finitely-funded state program, MinnesotaCare. This program has come under fire by Pawlenty’s critics as being a worse choice for public healthcare financing of this patient population, because costs to cover this high-risk demo will essentially cost the state more (since funds are not from the state’s general fund but from the more restrictive Health Care Access Fund).

GAMC beneficiaries who transition to MinnesotaCare under the governor’s proposal will have to renew membership with the new payer when the transition period ends, increasing the possibility of the loss of coverage — only postponing the pending crisis to access to care, according to Democrats. An interesting time for a bill whose language stirs passions equally among ideological camps in Minnesota, and one that appears achievable — at least for another 16 weeks. | LINK

1. In spite of a veto, the MN Senate has enough votes on the Dem side to override, creating a cushion. [↩]

Unemployment still sits at double digits (approx 10%) in the U.S. At the end of this month, the extension of COBRA benefits for the newly and longer-term jobless is set to expire — unless the Democrat-controlled legislature passes yet another extension based upon President Obama’s so-called “paygo” law.

Emergency spending would be exempt from typical tax increases or cuts amidst the backdrop of a national deficit. Centrist Democrats, under pressure from more left-leaning colleagues, will probably ask for discretionary spending under this statute — further stoking the ire of Republicans who voted against it in the first place, citing a slippery slope over what would be deemed “emergency spending”. | LINK

If Obama ever wished he could tell Insurance to just go and “take a hike”, I’m sure he wouldn’t mean it in a literal sense. A California-based insurance company’s decision to raise policyholders’ premium rates by as much as near 40% has prompted a state inquiry and the ire of HHS Sec’y Kathleen Sebelius. The attention the White House is giving this case at a time when reform efforts are rocky is somewhat of a balm for the president’s increasingly wounded pride on the effort to promise wider healthcare access and affordability as dictated during his campaign for the nation’s highest office. Why would an insurance company, even if it is for-profit, create such a negative PR issue for itself at a time when unemployment — and by extension, healthcare inaccessibility — in California and nationwide are at such cripplingly high levels?

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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

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.

President Obama’s healthcare initiatives are, once again, upfront in the 24-hour news cycles this week — albeit for reasons he probably would prefer not experience in the one-week run-up to his second SOTU address. Before all of the current negative sentiment surrounding health reform became the norm, there was a halcyon period for the new president, and it was about a year ago when he took office. Barack Obama’s election as the 44th U.S. President arrived fresh with bold promises of a completely revamped healthcare delivery system that would revolutionize access for the vast majority of U.S. citizens like no other piece of legislation since the Medicare entitlement over 40 years ago.

The talent pool from which the new president was to draw resources to revolutionize healthcare delivery included, at its centerpiece, the drive for innovation in the age of the electronic medical record. The ability for patients-as-consumers not only to have control over their healthcare information, but also have immediate access to it holds great promise for positively influencing efficiency in health information dissemination. Lower costs and less waste are to be the results of this innovation. Obama’s penchant for tech only adds to his administration’s zeal in making this happen.

Search giant Google made headlines when it entered the hallowed space of patient information and medical record retrieval. Of course, this caught the attention of the Obama administration, as it has already implemented Google as one of four key players in a demonstration project involving Medicare beneficiaries’ health information and records retrieval. Another up-and-coming HIT company targeted by the Obama administration as part of this CMS demo project is MediConnect. This company has emerged as one of the few major players in the new and thriving electronic medical records industry after growing nearly 800 percent in the past four years and is now serving some of America’s largest health payers and life insurance carriers.

I recently had a chance to interview its CEO, Amy Rees Anderson, and gauge her thoughts on the brave new world of this patient-as-consumer driven technology and what it means in the overall plan for healthcare reform. Part II of this interview will be posted on Doctor Pundit next week.

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DP: You are the CEO of a company fresh off an acquisition and explosive growth over the past 4 years. Where do you see the impact of the electronic health record (EHR) and the patient’s utilization of it in driving healthcare delivery efficiency over the next decade?

Ms. Anderson: I believe it is critical for patients to get involved in overseeing their own health care. If you really think about it, as consumers we often spend more time researching what car to drive then we do on our healthcare decisions.

In order to get consumers involved, it will take two main components 1) help them gain access to their medical records and 2) help them understand what is in those records so it becomes more meaningful to the consumer.

As we can accomplish these two things, which we believe MediConnect now offers with the combination of our record retrieval services and now the acquisition of PassportMD, the online Personal Health Record system, we can help consumers to get involved in knowing and understanding their own healthcare. As the adoption of these types of services grow, consumers will ultimately be what forces the facilitation of transferring medical information between their own medical care providers. The patient is really the only person who can build their entire health record by keeping every record from every care provider in one central repository which they can either directly access or grant access to certain portions to the people they feel need that information in order to best guide their healthcare.

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The funny thing about 20/20 vision in politics besides its keen ability to note history as it unfolds in the political process…is the ease with which it gives pundits in any genre a basis to pontificate^[1] or, rather…create, new issues and stories.  A recycling of information, if you will — the lifeblood of the blogosphere.

For Doctor Pundit’s inaugural accounting of its yearlong then-and-now pontifications on healthcare policy, we begin with an issue whose posting on this blog became its #1 blog entry for all of 2009 (according to Google Analytics statistics). Obama’s ascendancy to the the highest elected seat in the land carried along with it the hopes and dreams of the disenfranchised in this country who were hungry for change — any change — from the stranglehold that (they thought) was the Bush administration’s clamp on any meaningful attention to domestic policy in favor of its affinity for foreign policy and the War in Iraq. Healthcare was just one of those domestic policy points Obama supporters were clutching as possible rallying points for galvanizing their candidate’s ability to win the nation’s highest office — one which, for the first time, seemed a real possibility for an African-American candidate.

Enter Barack Obama, who not only won the 44th presidency, but also answered his party’s mandate in doing so. As part of his commitment to the people who placed him there (or to himself, as healthcare policy reform was as self-serving a legacy accomplishment for Obama as was any other domestic issue), Obama would finally make healthcare accessible to all. And he would get the Republicans and Democrats — and Pharma and Insurance — to work together to make it possible. Lofty? To Obama, at the time, not especially.

Apparently, expansion of the federal government’s role in financing Medicaid is a priority. According to the WaPo, Obama plans on allowing states temporarily to sign up jobless residents for Medicaid, with the federal government for the first time paying the entire cost of doing so. Even more boldly, the new president will also provide “unprecedented” federal subsidies to increase the affordability of COBRA, a temporary coverage mechanism for laid-off workers that, for many, remains unaffordable.

Fast forward 12 months later, and Obama is fighting for not only a candidate’s political life but also his own legacy as it applies to the reform of healthcare on a national level. A year ago, Obama had high hopes on expanding both Medicare and Medicaid to deliver high quality healthcare to those who needed it the most. At the time, it appeared to Obama, at least, that cost was no object. A year later, multiple iterations of CBO analyses have shed light on what lawmakers, Obama, and now the American people know only too well: Obama’s promises to increase healthcare access to the almost 50M uninsured have broken down on a massive level, its overarching meaning reduced at this moment to a vote this Tuesday in the state of Massachusetts on an open U.S. Senate seat. Twelve months and thousands of contentious healthcare townhalls later, Obama’s dreams of the affordability, bipartisan entreaties, and corporate cooperation of Pharma and Insurance with respect to healthcare reform are turning into a cruel reality on how he just seemed to lose all control of the debate.

1. …or rant, although I’ll try to stay away from heavy-handed verbal drama [↩]