The Baltimore Sun reports today that “The United States lags “at least a dozen years” behind other industrialized countries in adopting electronic medical records, according to a study published yesterday in the journal Health Affairs” authored by Prof. Gerard F. Anderson, Johns Hopkins Bloomberg School of Public Health and others. The report faults the government and insurance companies for failing to fund the initiative. I have not read the report, but I wonder whether the authors considered the fact that health insurers have spent millions of dollars over the past decade to come into compliance with the HIPAA administrative simplification standards at Congress’s direction?

Prof. Herbert presented an interesting price transparency report to Congress in March 2006. Here’s a link to a PDF copy.

The Senate majority leadership’s push to pass the Enzi small business healthcare reform bill has stalled, according to the Washington Post, and the minority leadership may apply the coup de grace today. The President has endorsed this bill; the House has passed a substantially similar version (H.R. 525) last year, and business community strongly supports it. However, the Democrats, state insurance regulators, many insurance companies, and patient advocate groups oppose it.

Steven Pearlstein of the Washington Post had an interesting health care reform in yesterday’s paper and held an online chat to discuss his article. In his article, he mentioned three “fresh ideas” for small business health care reform:

• A plan offered by Katherine Swartz of Harvard’s School of Public Health to have the federal government provide specific stop loss insurance for claims over $50,000 (subject to 10% coinsurance) funded by a tax on premiums. “This would equalize premiums and reduce the incentive for insurers to ‘cherry-pick’ the healthiest employee groups.”
• A plan offered by Michael Porter of Harvard Business School and Elizabeth Olmsted Teisberg of the University of Virginia’s Darden School of Business to price fix all hospital and physican charges regardless of payor. “That would eliminate the massive cost-shifting that favors big employers and big insurance companies.” (Of course the most massive cost shifting is done by the federal government’s Medicare, Medicaid, and TRICARE program not these payors, and in my view, you can date the health care cost problem from the time when Medicare shifted to a prospective payment/DRG system for compensating inpatient hospital care in 1983. But it’s always easier to blame the insurance companies.)
• The recently enacted Massachusetts state mandate requiring the purchase of health insurance.

If these were the freshest ideas that we’ve got, I would be worried.

The Washington Post reports that the Senate minority leadership is now considering a filibuster of the majority’s small business health insurance reform bill, S. 1955. The Senate majority is trying to line up support for a cloture vote. The President has expressed his support for the bill.

As I mentioned in a recent post to this blog, the recent HHS unified agenda states that the proposed rulemaking for a HIPAA-mandated unique health plan identifier was withdrawn. This surprised me as I had understood that HHS was close to publishing a proposed rule, and there is no privacy issue associated with this identifier. With help from my colleague Theresa Defino, I have learned that HHS has gone back to the drawing board on the unique health plan identifier and the agency therefore described the proposed rule as withdrawn because HHS does not currently have an anticipated publication date for that proposed rule. But it is still in the regulatory pipeline.

The U.S. Senate’s Republican majority leadership is now holding a Health Week to consider health care related bills that the House passed last year in different forms. Yesterday, the Senate leadership failed to break a filibuster over a medical malpractice liability reform bill, S. 22. Today, the Senate is considering a small business health care reform bill, S. 1955. The Senate’s Democrat minority leadership reportedly does not plan to filibuster this bill, but they would like an opportunity to hold a vote on their own small business reform bill, S. 2510, which would create a quasi-FEHBP for small businesses (under 100 employees) that OPM would administer. I’ll keep you posted.

The Center for Affordable Health Insurance released the results of a Zogby nationwide poll which finds that 84% of Americans agree that hospitals, doctors, and pharmacies should post their prices for all goods and services and that 79% of Americans are likely to price shop for health care based on that information. The margin of error is plus or minus 2.9%.

The Center for Studying Health System Change released a report yesterday stating that “After remaining stable since the mid-1990s, the proportion of U.S. physicians without any managed care contracts rose from 9.2 percent in 2000-01 to 11.5 percent in 2004-05.”Compared with physicians with one or more managed care contracts, physicians without managed care contracts are more likely to have practiced for more than 20 years, work part time, lack board certification, practice solo or in two-physician groups, and live in the western United States, the study found.”

Tip of the hat to my journalist friend Theresa Defino for pointing out this interesting study.

On May 1, 2006, President Bush spoke before the American Hospital Association (AHA) convention. He had the following comments on price transparency: “My administration is working with the AHA and other health care associations to provide patients with reliable information about prices and quality on the most common medical procedures. And I want to thank the AHA board for adopting a resolution this week supporting transparency. I appreciate your leadership on this vital issue. (Applause.) “We must work together to get patients the information they need so they can get the best quality care for the best price. If you’re worried about increasing costs, it makes sense to have price options available for patients. That’s what happens in a lot of our society; it should happen in health care, as well. By increasing transparency, the idea is to empower consumers to find value for their dollars and to help patients find better care and to help transform this system of ours to make sure America remains the leader in health care. “Secretary Leavitt has met with leaders in the health care industry in 13 cities to encourage them to work with the Department of Health and Human Services to increase transparency in the marketplace. We’re asking doctors and hospitals and other providers to post their walk-in prices to all patients. I directed the Department of Health and Human Services to make data on Medicare’s price and quality publicly available on the Internet. The first data will be available to all Americans by June 1st. We’re also asking insurance companies to increase health care transparency by providing their negotiating prices and quality information to their enrollees. And the federal government will do the same. “My administration will be requiring transparency from insurance plans participating in federal programs. Beginning this year, the Federal Employees Benefit Program and the military’s Tricare system are asking contractors to begin providing price and quality information. “Today, I’m asking for your help. Every hospital represented here should take action to make information on prices and quality available to all your patients. If everyone here cooperates in this endeavor we can increase transparency without the need for legislation from the United States Congress. By working together, transparency — to increase transparency, we can help lower costs.” Here’s a link to the AHA’s new price transparency policy. The AHA asks for federal standards on the presentation of pricing information and for insurers to provide an explanation of benefits before care is provided – an advance EOB. (I believe that easier said than done.) According to the AHA, Aetna is piloting an advance EOB in Cincinnati, OH. AHA also points out that the amount of pricing information that a consumer needs depends on their type of health care coverage.

The Washington Post reports today the death of Yale University professor Albert Reiss Jr. who coined the managementspeak phrase “proactive.”

Medco , a major prescription benefits manager, released its first quarter earnings today and in doing so it announced an agreement in principle on financial terms to settle the False Claims Act lawsuit pending against it in the U.S. District Court located in Philadelphia. The lawsuit relates to Medco’s FEHB Program business.

Marketwatch.com reports that

“Medco said it’s reached “an agreement in principle on financial terms” with the U.S. Attorney’s office, with final disposition contingent on the parties striking what the company called a “corporate integrity agreement.”