Weekend Update / Miscellany

Congress is in recess until just after Labor Day. The Washington Post reports that "Senators headed home for their August break Thursday [August 6] amid an escalating partisan battle over health-care reform, with a small band of lawmakers [the three Democrat and three Republic Senators from the Finance Committee] hoping to keep their delicately negotiated compromise alive until Congress reconvenes in September."

Also on August 6, the National Business Coalition on Health sent the letters to the President and Congressional leaders offering five recommendations for value based health care reform --

1) measuring the comparative effectiveness and performance of health services and providers; 2) making such information easily accessible and transparent to the public; 3) reforming the fee-for-service payment system; 4) empowering consumers to make better and more informed choices along the full spectrum of their health and health care journey; and 5) creating a failsafe mechanism and establishing an
independent entity to insure that serious cost containment measures are taken in
response to escalating health care costs.

I noticed that the Coalition's proposals resemble recommendations made in a 2008 Blue Cross Blue Shield Association report titled the Pathway to Covering America.

Speaking of reforming the fee-for-service payment system, the American Academy of Family Physicians last week posted a web site intended to held family physicians transition to a medical home centered practice.

The Centers for Medicare and Medicaid Services announced that the agency is resurrecting a pilot program to competitively bid for Medicare durable medical equipment providers in nine regions. The "rebid" will begin in October 2009.

Top management of Microsoft and Google encouraged the Obama Administration to incorporate web based solutions such as the Microsoft Healthvault and Google Health as a key part of its health information technology plan according to a Nextgov.com article.

Eric Schmidt, chairman and chief executive officer of Google, told top health
technology officials at a meeting of the President's Council of Advisors on Science and Technology that * * * like the Google and Microsoft applications, the national health IT system should be based on Web records that patients can control. In addition,
current electronic health record systems are proprietary and don't interoperate,
said Richard Levin, president of Yale University. "What is out there is not very
good," he said. "The reality is dismal."

The New York Times offered a report today on the privacy issues affecting these services.

Companies like Google, Microsoft and WebMD see a lucrative business opportunity in assembling and holding personal health records. Patients and their doctors would be able to consult the records wherever and whenever needed. But the companies themselves recognize that they have work to do to persuade consumers and physicians that records will be safe and protected.

Although as many as one in four adult Americans are currently offered an online personal health record, by a health plan or physician’s office, most have not taken up the offer.

Google, Microsoft and WebMD all say they will not show advertising alongside a person’s health records. But visitors to WebMD, Google Health and Microsoft’s site, HealthVault, see ads for drugs for diseases like osteoporosis or acid reflux as they seek information on an array of ailments.

Technology experts say identities of viewers and their health interests are often captured at the moment they click on online ads for a drug. That provides the advertiser with a prospective customer to pursue online or by mail.

“Personal health records linked to advertising, even indirectly, put them in the hands of marketers and profilers,” said Robert Gellman, an independent privacy consultant in Washington.

I find the lack of use of personal health records interesting. I think that the lack of use is more attributable to the fact that people just aren't that interested at this point in these online records than to privacy concerns. That could change as more features are added and demographics change. Finally, it's worth noting that the HHS rules that will trigger the 30 day implementation period for the new nationwide health information security breach notice requirement are due to be issued within the next ten days.