Thursday, December 31, 2009
The iPod changed everything – Ten years ago, if we wanted to buy music, we walked into a music store and purchased a CD. Today, we (or at least the vast majority of us) download it from iTunes and then play it on our iPod or iPhone, oftentimes through a hookup to our car or home speakers. CDs are nearly gone. Standalone music players, gone. Most music stores, gone. Most other web-based music downloading services (including the illegal ones), gone. Apple’s formula? Easy to use devices. Easy to use software. Easy way to connect the device to the software. Easy, easy, easy.
Convergence counts – Two co-workers today showed off their Christmas gifts. One displayed her new Amazon Kindle, the other a Barnes & Noble Nook. And both are great. For a variety of reasons (including some noted in the iPod paragraph above), digital readers are taking off and in ten years we’ll look back and note that they became the preferred and dominant mode of distributing content. But, as cell phones get smarter and laptops get better, won’t we want to read books on those instead? Just as the iPhone showed us that one device can be your phone, portable computer, music player (and for some, your GPS, camera, video recorder, etc.), I think it’s likely the trend toward technology convergence will continue. So, either Kindles and Nooks will be completely replaced… or, they will need to morph into more capable and versatile devices themselves.
The digital age – Ten years ago, photography pros and hobbyists debated whether digital or film ruled. It was a religious argument: heated, opinionated, and no one was ever willing to concede to the other. But here we are on the verge of 2010 and that debate, other than among the esoteric elite, is over. Walk into any camera store and try to buy a film camera… just try. And while film still offers artistic benefits through greater dynamic range and greater subtle variations across the tonal spectrum, it’s all about digital now. Why? Prices have fallen, quality has gone up and the convenience of shooting photos, gaining instant feedback on the quality of the image, and then being able to store the best shots (and delete the worst) are far too compelling. And, now all of us can create holiday cards, high quality books, slideshows, movies, and other vehicles to display our work… and so we’re not going back.
The connected society – We can (and should) argue whether this is a good thing or a bad thing, but today, all of us can and frequently need to be connected nearly 24x7. Remote access to email systems and gizmo cell phones have made it possible to work from nearly anywhere and at any time. Social networking and communication websites have given rise to an “always connected” society. During the next ten years, either this trend will continue… or there will be a backlash such that increasingly people will say that enough is enough. I predict the former as being constantly connected is addicting, much the same way instant gratification and greater convenience are. Once you get used to something…
Technology is always touted as making-our-lives-easier and improving-quality-of-life.
Wednesday, December 30, 2009
Who doesn’t want to live longer?
A new study by the MacArthur Research Network on an Aging Society states that: “the current forecasts of the US Social Security Administration and US Census Bureau may underestimate the rise in life expectancy at birth for men and women combined, by 2050, from 3.1 to 7.9 years.” Here’s the link (click here). According to the authors, the key conclusion is that: “The cumulative outlays for Medicare and Social Security could be higher by $3.2 to $8.3 trillion relative to current government forecasts.”
BNET’s take on this?
And that’s only the beginning. With anticipated scientific breakthroughs in coming decades, people could eventually live to 150 years of age, says Dr. Steven Joyal, an official of the Life Extension Foundation (LEF), a nonprofit organization that promotes research on how we can live longer and healthier. The MacArthur paper, in fact, says that some experts believe the average life expectancy could hit 100 by 2060.
What’s more, Joyal tells BNET, the conquest of disease and the slowing of the aging process will lead to a sharp decline in disability, allowing people of advanced age to function as well as they did when they were much younger. “In other words, a 90-year-old person could have the same mental and physical capacity as somebody 40 or 50 years old.”
Good news. But, the current health reform debate began on the note of not only trying to expand coverage for the uninsured but also with a goal of reigning in escalating health care costs. The culminating House and Senate versions are long on increasing coverage but fairly short on managing costs. There is movement in the right direction (e.g., quality based reimbursements and the formation of “accountable care organizations”), but health reform, in reality, turned into health insurance reform.
In the current debate about affordability, which has moved into the background as senators re-strategize during the holiday break, if cost estimates are underestimated for the reasons noted above, then the question of affordability ought not remain in the background.
Tuesday, December 29, 2009
Tweeting makes some sense to me. It’s a way to announce new blog posts, to promote some professional topic of interest, to follow a specific news story as it develops. For me, I do all those things… and occasionally throw in something from the other parts of my life, such as a photo or brief comment on a movie or restaurant I recently experienced.
But the holiday season has given me a new reason to ponder the purpose and value of twitter. Why? I’ve noticed that many of the twitterers I follow have used the opportunity of a few days off or a year-ending vacation to continue their twittering routines. Not everyone, mind you. President Obama has been silent about the good meals he’s had in Hawaii or the medical emergency that recently hit his friend’s child.
But everyone else? Among those I follow, I’ve been reading about European vacations, opinions on the year’s best movies and albums, whether Avatar is worth the hype, favored cocktails, and family Christmas traditions. Right there on my iPhone, I’ve been offered personal glimpses into the lives of people I had previously only viewed through carefully managed professional windows. Two questions pop up: (1) is this a good idea? and (2) should I throw caution to the wind and begin to peel back the onion publically myself?
On the first point, the Boston Business Journal ran a piece several months ago about CEOs blogging and tweeting, concluding with… no conclusion. They noted that there are mixed opinions on the subject and that it was, ultimately, too early to tell what kind of impact it might have. But their stories about CEOs posting their daily weight as part of their weight loss program and discussing whether the latest Star Trek movie is, in fact, the best of the series, made me wonder whether charging full on into a fully transparent world doesn’t have a downside as well.
Personalizing and demystifying those whom we interact with on a professional basis is, inherently, not a bad thing. In general, I think it’s a good thing. But when we blend worlds so much, do we lose a bit of the respite and release we gain from maintaining some measure of seclusion and privacy? We have all learned that balance is important to our health and well-being, but if we’ve blurred the lines so thoroughly between worlds… how will such balance be possible?
Remember George Costanza’s lament, that it’s not good, “when two worlds collide!”
And so despite some occasional lightly personal posts and tweets, I’ll probably keep my own worlds apart for the time being.
Now about my brother-in-law…
Monday, December 28, 2009
After seeing a show at the Providence Performing Arts Center, we visited nearby Federal Hill for dinner. Though it lacks the scale of New York's Little Italy or charm of Boston's North End, there's an intimate and vibrant feeling you get from this small city cluster of Italian restaurants and shops, even on a drizzly winter evening. This Dolce Villa section, featuring brightly lit pastel colored buildings is a highlight. The gnocchis at Constantino's next door was another highlight. Recommended.
Thursday, December 24, 2009
It’s quiet here in Charlestown and I have some quiet music playing in the background (Whitney Houston’s “Do You Hear What I Hear?”… what a voice!). I thought I would take the opportunity to wish all of you a happy holiday week (Merry Christmas, Happy Hanukkah, Happy New Year, etc.).
Word is breaking now that the US Senate has passed a comprehensive health reform bill this morning. Though a lot of work remains to try to pull together a combined House and Senate package that is acceptable to all, this feels like a historic moment nevertheless. And big questions remain, such as how can we pay for all this? But I do believe that one of the true sparks for this effort comes from a desire to be a compassionate society. Having working in a community health center and an acute care hospital, I know that we basically do provide services for all… but the services are disconnected and often based solely on urgency. By offering preventive and basic primary care services to the currently uninsured, we improve people’s lives and, in the long run, make health care more affordable. As you know, good chronic disease management improves health and cuts costs in ways that frantic visits to the ER never will.
As I’m continuing to meet all of you and to learn about the VNA of Boston, I now have begun to hear more from those who rely upon us. And from those who entrust their patients to our care. The true, original spark for the VNA of Boston itself was a desire to be a compassionate society. We are motivated and inspired by our mission… which was born some 125 years ago on the waterfront of Boston and which is no less relevant or vital today. No one contests the value of our mission and the role we play, but it’s evident that we can back that up too. We back it up with state-of-the-art home care services, supporting technologies, and a staff and management team who work hard to make sure we live up to our storied heritage.
I’ve been focusing over my first few months on our budget for next year, our strategic planning goals, and meeting as many of you as I possibly can. I’m even starting to remember some of your names (but please be patient if I don’t remember all of them… there are a lot of you!). We’re well positioned for the future. But we’ll have some challenges too as we need to critically assess our technology platform in an evolving industry, make sure we’re ready for the changes that national health reform and local payment reform will bring, continue to focus hard on patient and customer satisfaction, and continue to concentrate on improving outcomes and managing our resources carefully.
Thank you for your part. Whether you provide compassionate care in our patients’ homes (including on snowy days such as last weekend) or work behind the scenes making sure our systems run without a hitch, that our employees get accurate paychecks, report information out properly and on time to regulators, generate good information for managers to make decisions, smoothly process referrals and payments, or make sure our facilities are clean and efficient… you are an important part of the VNAB story, the VNAB mission. We have a lot to be thankful for in 2009… I know I do.
Wishing you and your loved ones a very happy holiday season and a happy, healthy 2010. Enjoy the next few days.
… and now the hardest part of all… fashioning a bill that the House, Senate and White House can all support.
The Senate vote was 60-39 following party lines. Now, key leaders in both houses must get together to come up with the compromise bill for the President’s signature. There are pretty significant differences between the two final versions on issues such as how to pay for the expanded coverage, whether there will be a public option or not and, of course, abortion coverage.
As I commented on recently, public opinion is now working against final passage and the Republicans in office, more united than ever, are focused on slowing and defeating any measure of reform. And although the President played a low key role during the heated Senate deliberations, expect him to step it up in the next phase. He realizes that his own direct involvement could be the difference maker at this point. "We hope to have a whole bunch of folks over here in the West Wing, and I'll be rolling up my sleeves and spending some time before the full Congress even gets back into session, because the American people need it now," the President remarked yesterday.
The original hope was to have something in the Oval Office for the President’s signature by year end; obviously that won’t happen. But, given the wrangling and recent shift in public opinion, it’s pretty remarkable that we’re even this far along by Christmas Eve. It appears likely that the President will hope to have this all wrapped up by the State of the Union address early next year.
Wednesday, December 23, 2009
Big business in America is bracing for health reform and with the notable exception of the U.S. Chamber of Commerce which is still calling for defeat of reform, most groups are lining up behind it and saying they want to work to improve it in the final negotiations of early 2010.
Retailers are hoping for a longer delay before new employees quality for subsidized benefits. Large employers want to revise the Medicare tax provisions that would limit earnings. Small construction companies want an exemption from employee coverage. Nearly all companies are concerned that new taxes and fees will drive premiums up, especially for smaller employers. Though Democrats want to limit tweaking on the combined bill, expect the business community to continue to speak up.
The new taxes? Insurance companies, medical devices, high income seniors, deluxe health plans and tanning salons will all be taxed. If you are a well compensated, aging insurance executive who requires some type of medical device and enjoys tanning…
Given the Democratic majority in Congress, it's unlikely the Republican charge will gain much steam. But, this could signal the beginning of a multi-pronged legal attack that could tie up the implementation of the new law for years. And given how the legislative branch swings left, then right, then left, etc.... perhaps keeping this in the courts for a while could push this to a time when a repeal of the reform law could be possible.
Tuesday, December 22, 2009
Monday, December 21, 2009
Harry Reid, majority leader, said: "We are reshaping the nation. With this vote, we're rejecting a system in which one class of people can afford to stay healthy, while another cannot." Republican leader, Mitch McConnell, described the milestone as "a historic mistake," noting that there was some significance to the "dead of night" wranglings that resulted in the historic vote. According to McConnnell, the "final product is a mess."
The Boston Globe is reporting that Senate rules require three successive votes be held 30 hours apart. This will lead to a 7PM vote on Thursday evening... Christmas Eve. Republicans can allow the final vote to occur earlier, but you won't want to bet your house on it. John McCain announced: "We'll fight until the last vote."
Remaining for the Democrats? Resolving the differences between the House and Senate versions regarding abortion restrictions, the public option, tax requirements, and the issue of coverage for illegal immigrants. All BIG issues. If the House holds firm on any of the major compromise issues, the delicate and fragile alliance among key senators could crumble.
The political implications of all this? With midterm elections coming next year, expect Republican candidates for office to decry the middle of the night deal making and politicking that accompanied this process.
Saturday, December 19, 2009
Friday, December 18, 2009
Walt was right. And the thousands upon thousands of apps being distributed by the bucketload every hour of every day from Apple's App Store prove it. My most recent case in point? You're witnessing it right here and right now. BlogPress is an application that allows you to fully manage your blog from your iPhone. The possibilities seem endless as it's now completely possible to post at any time and in any place you can use your cell phone. Note that this post is my first attempt at blogging while taking my Lhasa Apso, Shadow, for his nightly walk.
And assuming I don't walk into a tree or get hit by a car, this could be pretty cool. Now if they would just write an app that would let you control the weather, both Shadow and I would be much, much happier right about now.
- Posted using BlogPress from my iPhone
According to a new Wall Street Journal/NBC News opinion poll, for the first time since conducting the poll, more Americans are saying they'd rather keep the system we presently have intact rather than passing the current Democratic sponsored bill. 44% of respondents prefer to take a pass on the proposed system overall while 41% want to enact the current bill. Just two months ago, the numbers were reversed with 45% wanting a comprehensive reform package and 39% hoping to stick with the current system.
Legislators who are coming up on reelection bids will watch polls such as this very closely... and that's bad news for the White House.
Home health care has received much attention lately as part of the national health reform debate — and rightly so. These services are a vital component of the health system, caring for the elderly, people with disabilities and the chronically ill, and helping patients avoid higher cost service use, like acute-care emergency room visits, lengthier inpatient stays or premature nursing home admission.
Unfortunately, and ironically, even though home care is a proven cost-saver, federal health reform measures would cut disproportionately from in-home services. At approximately 4 percent of overall Medicare spending, home care is slated for cuts as high as 10 percent under the House and Senate plans.
Mr. Leonhardt claims that home care profits warrant such enormous cuts. Not so in states like New York, where a recent analysis of independently certified financial statements found that an alarming two-thirds of home care agencies are now operating in the red. For the last seven years in a row, these agencies have been losing money treating Medicare beneficiaries because Medicare has underreimbursed home care services.
In many respects, home care is a victim of its own success, self-innovation and responsiveness to health delivery trends. The level and types of services delivered in the home today are increasingly complex. Providers have also witnessed a significantly greater number of patients with intensive health needs; more home care patients today are aged 85 or older, require skilled services, suffer from chronic conditions and exhibit cognitive deficits.
These trends, while having increased our reliance on home care, have also shortened hospital lengths of stay, averted acute-care E.R. visits and allowed people to remain in their own homes — all at a significant savings to health care, and to the benefit of patient health and well-being.
Thursday, December 17, 2009
Former Democratic National Committee Chair Howard Dean stated, after the collapse of the age 55-64 Medicare buy-in option designed to appease Connecticut Senator Joe Lieberman: “This is essentially the collapse of health care reform in the United States Senate.” Nebraska Senator Ben Nelson is refusing to sign the bill without strong anti-abortion language and others are similarly acting as though their vote is the only one that counts. With the balance of yays and nays so tight, each vote is actually that important.
Meanwhile, Majority Leader Harry Reid is expressing confidence that the bill will pass while the President is tweeting that the Senate is "on the precipice of a historic decision."
We ought not forget though that even with the increasingly watered down version that is emerging, there are some significant changes coming (assuming the bill gets to a vote and survives). These include: Medicaid program expansion, movement toward outcomes-based (or at leased influenced) reimbursement for providers, consistent removal of the pre-existing condition clause and the inclusion of some 30+ million Americans who today do not have comprehensive health care coverage.
So... depending upon whether you are a glass-is-half-full or glass-is-half-empty kind of person (i.e., liberal leaning or conservative leaning), you may be getting ready to declare victory for having passed the most comprehensive health reform package in history... or having defeated the most ambitious health reform package in history by successfully diluting down all of its ill effects.
I guess it all depends on how you look at it.
Wednesday, December 16, 2009
Living in an email, Facebook, instant messaging, texting, Twittering world where communication is fast and instant, taking the time to select, order, pay for, prepare and mail handwritten correspondence seems archaic, prehistoric. Maybe even ridiculous.
But perhaps it is because of the lightening pace of communication today and the fact that credenzas everywhere lie bare, that taking the time to send old fashioned holiday cards does make the most sense, now more than ever. Perhaps today a holiday card expresses a deeper sentiment. While a "thanks for your business" note on a card a few years ago might have seemed perfunctory, superficial... maybe now it suggests that the sender really does appreciate the business and that his or her willingness to take that time to do what seems antiquated and even unnecessary is propelled simply by a timeless sense of true appreciation. And maybe that lone card sitting in someone's office stands as testimony and tribute to the personal touch that seems increasingly rare.
I think I'm on to something here. I'm going to Tweet this out to all of my followers right away...
And so, the major, groundbreaking health reform initiative seems to be shrinking each day.
Even so, Senate Democrats are putting their best faces forward. "There's enough good in this bill, that even without those two (things), we've got to move it," said Tom Harkin of Iowa, Chairman of the Senate Health, Education, Labor and Pensions Committee. With Christmas and the self imposed deadline of the year-end approaching, the question remains: will there be much left before the final vote?
Monday, December 14, 2009
According to ALEC's website (link here), their goal is to provide: "State Legislators with the Tools They Need to Fight ObamaCare". One cornerstone of the movement is to oppose the creation of health insurance exchanges for individuals and small business. They've been actively opposing the public option, but that has now been taken off the table. On the first point, according to ALEC: "a federal exchange would undermine states’ oversight role in health insurance and cause a substantial shift in the regulation of the health insurance market from the states to the federal government."
The internet is buzzing with reports that the force behind ALEC is the self-interested private health insurance industry. The Blue Cross Blue Shield Association has been specifically and repeatedly called out. Their response has been to admit the ALEC association, but also to point out that they maintain numerous relationships with a number of groups to advocate for their interests. It's no surprise that the insurance industry has long been warning against the ill effects of health reform, namely that private insurance costs will skyrocket.
So, front pages are suddenly absent reports about health reform. But that does not mean that those who oppose it have given up the fight.
Saturday, December 12, 2009
Friday, December 11, 2009
Well, it's weeks later and the frustrations remain. Actually, it's worse as the phone increasingly has a habit of freezing right when a call comes in. I'm sure I don't need to tell you that that can be... disrupting. But, thanks to the some good work by our IT Department, relief is on the horizon. Blackberries are coming, and soon. Next week. I jokingly tell our CIO that my present phone has a date with the hard surface below the Lenny Zakim (if you're from Boston, you understand).
So, even with this... I must tell you that I've returned to the iPhone. I'll be one of those guys you see carrying two cellphones. On my Bat Belt, I'm sure. Why? I miss the functionality of the apps I once used. I miss the ability to quickly look information up on-line and to communicate easily with people I work with and family members. I miss being able to see when movies are playing at the local theater, getting walking directions to a downtown restaurant and being able to to jot down notes that will mysteriously, automatically and reliably synchronize over the air (Evernote) with the software I run in the office. The Blackberry is great, but it too is no iPhone. This is a costly move for me, I know. Maybe too costly and one I'll regret. But I don't think so. The iPhone, obviously, has got me and good.
If you're interested in this topic, you might find this article (click here) to be interest. The author details how Microsoft has really missed the boat when it comes to handheld technology and how the future will come down to an Apple vs. Google battle.
Thursday, December 10, 2009
- On average, more than three women a day are murdered by their husbands or boyfriends in the United States. In 2005, 1,181 women were murdered by an intimate partner.
- In 2008, the CDC published data showing that women experience two million injuries from intimate partner violence each year.
- Nearly one in four women in the U.S. reports experiencing violence by a current or former spouse or boyfriend at some point in her life.
- There were over 248,000 rapes/sexual assaults in the U.S. in 2007, more than 500 per day, up from nearly 191,000 in 2005.
- The U.S. Justice Department's Bureau of Justice Statistics estimates that 3.4m persons were victims of stalking during a 12-month period in 2005 and 2006.
I'd like to introduce you to an organization that has worked hard to educate the general public, policy makers and government officials on the impact and prevalence of intimate partner violence. It's the Family Violence Prevention Fund. Their website is here.
This is a great time of year to remember this organization and to consider making a donation. Perhaps you can make a gift in someone's name. More information here.
Wednesday, December 9, 2009
On Tuesday, Sens. John Kerry (D-MA), Debbie Stabenow (D-MI), Susan Collins (R-ME), Olympia Snowe (R-ME), Blanche Lincoln (D-AR), Ron Wyden (D-OR), Arlen Specter (D-PA), Tim Johnson (D-SD), and Kirsten Gillibrand (D-NY) filed a bipartisan amendment to reduce the home health cuts in the Senate health care reform bill by nearly $5 billion. This comes on the heels of another amendment by Sen. Kerry — which passed the Senate by a vote of 96 to 0 — to prohibit any reductions in Medicare home health benefits.
National Association for Home Care & Hospice (NAHC) members are encouraged to contact their Senators to urge them to cosponsor the Kerry-Stabenow-Collins-Snowe-Lincoln-Wyden-Specter-Johnson-Gillibrand-Nelson amendment to reduce the home health cuts in the Senate's health care reform bill. Note that additional cosponsors can be added after the amendment is filed; Sen. Ben Nelson (D-NE) has just agreed to add his name as a cosponsor.
We’re fortunate to have Sen. Kerry’s support and leadership in this effort. Soon enough, we’ll have a new Junior Senator in Massachusetts… but in the mean time, interim Senator Paul Kirk will likely have an opportunity to weigh in as well.
Please call or email each of our senators, noting the following:
> Tell them that you work for the Visiting Nurse Association of Boston
> Thank them (particularly, Sen. Kerry) for their longstanding support and leadership in protecting home health benefits
> Urge him to continue the fight on behalf of the many thousands of patients we serve in and around the Boston area
Their contact information:
Kerry, John F. - (D - MA)
218 RUSSELL SENATE OFFICE BUILDING WASHINGTON DC 20510
Web Form: kerry.senate.gov/contact/email.cfm
It will take maybe 3 minutes … but the time to act is right now. You can make a difference!
Thanks very much,
Tuesday, December 8, 2009
Instead of a true public option, the Democrats have agreed to form a new Federal agency that would oversee private insurers. Additionally, the arrangement calls for Medicare to become available to unsureds over age 54; this marks a critical expansion of the program currently available to those over age 64.
"In voting to cut a half trillion dollars from the Medicare program for seniors, our Democrat friends undercut not only the roughly 40 million seniors who depend on Medicare. They also undercut their own promises about reform." U.S. Senate Republican Leader Mitch McConnell made the following remarks on the Senate floor Saturday regarding the importance of getting it right on health care reform: “The U.S. health care system is in serious need of reform. Costs are too high, they’re rising, and if we do nothing they’ll continue to consume a larger and larger share of federal dollars and of the budgets of millions of middle class American families, of young workers trying to get their start in life, and of seniors.
“For months, the Administration and its allies in Congress promised a solution to these problems, a solution they said would lower costs and help the economy. They assured us that under their proposal anyone who likes the health care plans they have would be able to keep them. And they said their proposal would save Medicare.
“But, in the end, what matters isn’t what we say. It’s what we do. And this week, the proponents of this plan did more with a single vote than they did all year in talking about all the things that their health care plan would do. How? Because in voting to cut a half trillion dollars from the Medicare program for seniors, our Democrat friends undercut not only the roughly 40 million seniors who depend on Medicare. They also undercut their own promises about reform.
“As I said, the President and Congressional Democrats have noted again and again that under their measure those who like the plans they have will be able to keep them. After Thursday’s vote, even Democrats are admitting that’s no longer true. Here’s how one of our Democrat colleagues put it: “We’re not going to be able to say that ‘If you like what you have, you can keep it.” And then he added, “… and that basic commitment that a lot of us around here have made will be called into question.”
“As for the oft-repeated pledge to save Medicare, well, nobody buys that one after Democrats voted Thursday to cut it by half a trillion dollars. These Medicare cuts will impact the quality of care for millions of American seniors. Nearly 11 million seniors on Medicare Advantage will see a reduction in benefits. Hospice care will see massive cuts. Hospitals that treat Medicare patients will see massive cuts. Nursing homes are cut. And more than $40 billion is cut from home health agencies — agencies that provide an appealing alternative to seniors who would rather receive the care and attention they need in the comfort and privacy of their own homes.
Friday, December 4, 2009
The Democratic response? Senate Majority Leader Harry Reid noted that rather than offering their own comprehensive plan, "the first and only plan Senate Republicans bothered to draft is an instruction manual on how to bring the Senate to a screeching halt."
As the Senate considers amendments, the critical question is whether the process can serve to strengthen the bill... or merely delay it.
Thursday, December 3, 2009
Wednesday, December 2, 2009
Senator John McCain, an active tweeter on the subject, has proposed an amendment that would eliminate $400b in Medicare cuts to hospitals, hospices and home care providers. U.S. Seniors are clearly concerned that expanding coverage to the presently uninsured will result in reduced coverage for them. Any and all suggestions of "rationing" are being rebuffed by those who cite the bill's long-term positive impact on cutting costs.
Another amendment has been introduced that would cover expanded preventive services for women, clearly designed to quell fears prompted by the recent recommendation that mammograms could begin for most at age 50.
The good news here seems obvious, but the bad news? The bill's already shaky financial footing is beginning to feel even more shaky.
Tuesday, December 1, 2009
Paul Levy wrote about this yesterday (click here), speculating that the implementation delay is intentional by the Obama administration... pushing the politically charged work out past the next Presidential election cycle. Here are a few other items worth considering:
- The proposed independent Medicare Advisory Board will recommend changes in Medicare reimbursement with limited Congressional oversight. Recommendations impacting hospitals or physicians are off the table through 2019. Expect other providers to be hit hard.
- Between 1 and 2% of hospital Medicare payments will be subject to quality and efficiency targets. Will the savings generated here be enough to offset the higher costs of the overall program? Payments to physicians could be altered based on utilization patterns, but the potential for that will be impacted by the usual process and it will take more political will than government leaders have been able to muster thus far.
- Accountable Care Organizations (ACOs) are introduced, but the currently fragmented system makes implementation difficult. If ACOs become hospital dominated systems, one has to wonder whether hospital systems will be able to effectively take the lead in driving costs down.
There's plenty to like about the proposed health reform legislation... and plenty to be worried about as well.
Monday, November 30, 2009
On George Stephanopoulos' Sunday show, Senator Bernie Sanders (VT) said: "I've got about ten separate amendments." Senator Sanders is not alone as the amendments begin to line up. The home health industry is hoping Senator John Kerry comes through with one that will minimize the negative impact on reimbursement for services. And interested parties everywhere are calling and writing their favorite senators asking for help. Reid, the President and other leaders will be busy over the next few days asking Senators to exercise caution for fear that the process may slow or even halt.
Much has been written and said about the demise of print media as the Internet with its instant access, real time delivery of information and flexibility in medium (computer, cellphone) takes over. Well, for the past few weeks, I've been experimenting with the Globe's new "GlobeReader" service. More info here. This is a paid service whereby every morning a fresh copy of that day's paper is downloaded to your PC (or Mac). Unlike www.boston.com, you have full access to the paper (including crossword puzzles), can increase or decrease font size, email links or full copies of articles, retain seven full days of content, easily navigate full articles, and "subscribe" on multiple home computers. You need Internet access for only the few minutes it takes to download that day's news.
Ultimately, we'll see if this service flies and whether the Internet generation, accustomed to reading news for free via web browsers, will find this a valuable way to get information. My own conclusion, after just a few weeks, is that this makes sense. Saving (i.e., clipping) articles is a snap, I can read the news wherever I can access a laptop (which is nearly most places these days) and I don't mind that this is environmentally friendly as well.
I'll let you know how it goes after another few weeks.
Saturday, November 28, 2009
Tuesday, November 24, 2009
- 216,000 children in Massachusetts have a diagnosable mental health disorder, 70,000 of which are deemed "severe"
- 32% of providers are not accepting new patients and another 39% have only 1-2 open slots available for new patients
And here's the one that caught my attention:
- 54% of providers of children's mental health services between the ages of 35 and 54 plan to leave direct care or Massachusetts within 5 years
Perhaps too much can be read into such statistics, but they do point out that the current problem of difficulty in accessing child mental health services is likely to get worse. Patients with untreated mental health concerns experience a greater number of health problems, a shorter life span, and suffer from a deterioration in quality of life.
What's the solution?
Friday, November 20, 2009
- Major provisions of reform (e.g., creation of health care exchanges, expansion of Medicaid to 133% of Federal poverty level) delayed from 2013 to 2014
- States can opt out of the government run public health plans (via individual state legislation)
- Beginning in 2014, most Americans will be required to purchase health insurance or face fines of $95 that year, growing to $750 by 2016; note that many worry that the fines are not stiff enough to motive enough to purchase insurance
- Employers are not mandated to provide insurance, but firms of greater than 50 employees who don't will pay a penalty if workers receive government subsidies to purchase coverage through one of the new exchanges
- New taxes? 5% on elective cosmetic surgery, an increase in Medicare payroll tax on individuals earning over $200,000 a year and couples over $250,000.
- High cost insurance plans (with yearly premiums of $8,500 for individuals or $23,000 for families) will be subject to a 40% excise tax - - a provision designed to reduce health care costs
- CHIP program not eliminated as some had speculated
- Rescissions (i.e., when insurers cancel policies once holders become sick) no longer possible
- Medicare will remove all copays and cost sharing on preventive services
The Senate could begin debate on this as soon as tomorrow.
Thursday, November 19, 2009
Wednesday, November 18, 2009
Tracking numbers such as these will become even more important as we head into next year's election cycle. The Senate is working feverishly to come up with a plan that will support the President's top domestic priority... but which won't prove too costly politically. And time is of the essence.
Tuesday, November 17, 2009
The more recent focus has been on the payer side of health care, hence the fact that many if not most discussions now describe this as health insurance reform. Big difference. The question is: why the change?
Cynics may answer that the powerful provider lobbies (AMA and AHA) and big businesses (i.e., the pharmas and equipment manufacturers) have found a way to successful apply pressure on legislators. Maybe that's true, but I wonder if the lawmakers have rediscovered the longstanding challenges associated with reigning in health care costs. The challenges pertain to the fact that while there are some excesses and inefficiencies in this sector (show me one where there are not), cost cutting efforts quickly get into the sticky issues of negatively impacting quality, limiting choice, and restricting care to some (aka rationing - and no public figure wants that association).
Early rhetoric, including the President's, centered around driving improved quality as a way to appropriately shift incentives and lower overall costs. Evidence strongly supports this general idea, but the current House reform bill and the pending Senate one don't seem to support these concepts as much as the early arguments indicated they might.
Monday, November 16, 2009
Thursday, November 12, 2009
- Some are speculating that the "real" deadline is mid-January, coinciding with the President's state of the union address; others, however, point to the intense pressure coming from the White House to get this done this year. Congressional leaders are stating a willingness to work seven days per week through the holidays in order to make this happen.
- Sticky items to watch are: the ability to opt out of the public option, the open funding questions, abortion and immigration issues
- Keep an eye on Maine's Olympia Snowe (she's not a fan of the public option); everyone is counting votes to see whether Democrats have the 60 votes necessary to break a filibuster
- Massachusetts Senator John Kerry is leading the charge to reduce the cuts to home health; he is working to gain bipartisan support
- The key issue relates to the offset provisions. Rules stipulate that to reduce cuts in one area, the proponent needs to come up with a plan to proportionately increase revenues or increase cuts elsewhere. This is going to be a tough proposition for Kerry.
- Look for a Senate version to emerge soon. Then the toughest work will begin - - melding the two bills together into something everyone will like.
- The likely Senate bill will contain fewer cuts to home health than the current House bill.
The VNAA is working to keep its members informed. And it looks as though perhaps not everyone will be enjoying the holidays this year.
Many of the posts here on this blog pertain to the current health reform debate. It strikes me that, ultimately, the likely impact on home health care will be painted with both of these broad brushstrokes.
Wednesday, November 11, 2009
I remember a recent tour of a brand new state-of-the-art ambulatory care center. I was directed to the set-ups in the patient care rooms and asked to consider the ergonomics of each workstation. A consultant had been hired to design the area where the clinicians sit and interact with the patients... and the computer monitors and keyboards that serve as gateways into an also state-of-the-art electronic health record system. Painstaking attention was paid to the placement of the large robot-like arms that allowed for optimal positioning of the technologies so that inputs and outputs could proceed unhindered. The chairs looked like they would have been at home in the finest Wall Street boardrooms and the tan oak desk was smart and attractive. It was an ideal environment.
Shawn and Nancy don't work in places like that. Shawn helped a woman recovering from knee replacement surgery navigate through a cramped bathroom and up and down a narrow flight of stairs as she stretched and pushed herself toward recovery. Nancy led me up three winding flights of stairs into a pleasant home where a newborn and his newmom were contending with the normal stress of the occasion and the not so normal stress of serious medical problems. Both clinicians bent over undersized laptops and entered critical medical information; Shawn hunched over his computer as he sat at the end of his patient's bed while Nancy leaned over and tapped onto the screen leaning against a pillow, inches from the baby's head.
Shawn told me that he had worked in a hospital for many years as a PT and that he would accompany his patients over to a designated spot where they could walk up and down a few steps. But now, he sees the actual steps where his patients live and the help he provides is real and impactful and immediate. Nancy explained, holding the actual containers that the mother uses to prepare the critical formula for her child, the precise proportions of water and powder. This is no classroom, no state-of-the art laboratory.
It is real. It is the ergonomics of life. And that makes a huge difference.
This raises some interesting questions regarding the individual clinician's right and responsibility to address patient questions and concerns about the future of health care coverage. Though many of the concepts being bandied about on the nightly newscast may be complex or nebulous for some, the general public is increasingly coming to understand that the system, love it or hate it, could begin to change drastically, and soon.
One could conclude that there's no place for politics in the exam room (or at a hospital bedside or in a patient's home) and so that the health reform topic is best left alone. Alternatively, one might decide that the conversation should focus merely on facts. Or, some may feel that it's entirely appropriate to bring personal opinions (and concerns, fears, etc.) into a dialogue with patients.
What do you think? Feel free to comment on this post.
Tuesday, November 10, 2009
Monday, November 9, 2009
Sunday, November 8, 2009
Saturday, November 7, 2009
Thursday, November 5, 2009
I worked out of our Southwest office in Braintree; this included a few business meetings, a lunch with the regional managers, and a nice informal get together with staff. The morning consisted of home visits and I was the guest of Ann Marie McGuire and Colin Highland. Ann Marie is a nurse and Colin is a physical therapist. We saw three patients
The first, a near 90 year old woman who lives with her sister, is experiencing CHF. She was gracious, vibrant and charming. Her sense of humor and spirit captivated me as I watched Ann Marie expertly enter information onto a laptop's touch screen, check vitals, and converse with her. The second patient, another near 90 year old resident of an assisted living facility, suffers from multiple physical conditions, requiring the expertise of both Ann Marie and Colin. I watched them interact with the patient and each other and was impressed with the hand-off of information between them. Colin and I stopped by the facility's nursing office and I heard from the staff nurse there that she appreciated the professionalism and exceptional communication she consistently receives from VNAB staff. She listened intently as Colin described what had happened with the patient and his recommendations regarding how he can continue to maintain his independence. The nurse told me that VNAB is distinguished from the other home health agencies by the comprehensiveness of its services and the quality of its clinical staff. Finally, Colin and I traveled to a senior residence and met a women recovering from hip replacement surgery. Colin walked with her to pick up her mail and spoke with her in a friendly and comfortable manner. It was obvious to me that this patient and Colin enjoy a trusting and warm relationship. When we departed, the patient thanked Colin and expressed her gratitude for the difference he and his PT assistant had made in her life. With the exception of having to contend with this patient's rambunctious Boston Terrier, it was an enjoyable visit.
I was not all that surprised to see the level of compassion and professionalism that Ann Marie and Colin brought to their jobs. Frankly, I expected that. What I was quite struck by, however, was how they were received by the patients. The three individuals we visited are vulnerable and overwhelmed by the complexity and burden of their ailments and treatment regimens. I saw that both Ann Marie and Colin had well established relationships with these patients and that their level of trust in their clinicians was extremely high. Ann Marie and Colin carefully explained what was happening and what was going to happen next. They described all of the positive observations as well as the concerns. They comforted and they lifted spirits. They offered hope and reassurance.
And I could see the effect of that in three glowing faces.
On some days, I set up shots, exercised great care and actually worked at it. Many days, however, I was flying around my normal day and just trying to grab a quick shot to check this off my to do list. The two pictures in the previous post are examples. Both were taken with an inexpensive point and shoot digital camera. Both were taken in the conference room near my former office. I set the camera to macro mode and in one photo, I pointed the camera up from the bottom of the vertical window blinds and fired away. The second, also on macro mode, was a close up of an ordinary office plant leaf. On my computer later, I jacked up the saturation, contrast and sharpening.