Edition One (2/3/09)

Daschle Withdraws Nomination
Boston Globe, 2/3/09
Tom Daschle has withdrawn as President Obama's nominee for health and human services secretary because of his failure to pay his taxes on time. Daschle, the former top Democrat in the Senate, apologized publicly and privately. Senators and Obama had stood by him, but Daschle withdrew today, saying he did not want to be a distraction. Obama said he accepted the decision with sadness and regret, the White House said.

House Panel OKs Part of Stimulus Bill With Health I.T. Funding
ihealthbeat.org, 1/22/09
The House Appropriations Committee voted 35-22 to approve a $358 billion portion of an $825 billion economic stimulus package that includes funds for health care I.T. investments and community health centers. The House Ways and Means Committee and the House Energy and Commerce Committee plan to hold mark ups on the portions of the stimulus package that fall under their jurisdiction. Both committees likely will consider the portion of the stimulus package that includes $20 billion for health care I.T., although some of the language for that portion of the legislation falls under the jurisdiction of the Energy and Commerce Committee alone.

Leavitt Warns of Pandemic, Foresees Health Care Reform
Deseret News, 1/27/09
Former HHS Secretary Mike Leavitt in a discussion with the editorial board of the Salt Lake City Deseret News spoke about the potential for comprehensive health care reform. Leavitt said a major problem with the U.S. health care system is that 16.5% of the gross national product is spent on health care that "rewards based on procedures, successful or not, and for treating sickness rather than keeping people well."

House Version of Stimulus Package Would Have 'Noticeable Impact,' CBO Report Finds
kaisernetwork.org, 1/27/09
The Congressional Budget Office released a report that found the House version of the economic stimulus package would have a "noticeable impact on economic growth and employment in the next few years," with much of the mandatory spending for Medicaid and other programs likely to occur in the next 19 to 20 months, CQ Today reports. According to the report, the stimulus package would cost $815 billion over the next 10 years, with about 65% of spending likely to occur by September 2010.

Privacy Standards Debated at Senate Hearing
CongressDaily, subscription needed 1/27/09
The Senate Judiciary Committee heard testimony on the debate over privacy standards for EHRs included in the economic stimulus package. A number of health care experts said that strong privacy standards could limit the ability of providers to exchange information and endanger the lives of patients as a result. However, others said that strong privacy standards are needed to obtain the trust of patients. According to CQ HealthBeat, the "general tone of the testimony was that the safeguards will do for now and can be improved later through new legislation or regulation." Meanwhile, Sen. Olympia Snowe (R-Maine) raised concerns about a provision in the stimulus package that would exempt unintentional disclosures of medical information from the privacy standards and an "excessively broad" exemption for disclosures related to research.

Some Fear Window is Narrow for Health Care Overhaul
Boston Globe, 1/28/09
Mindful of how delays sapped the political will to overhaul health care during the Clinton administration, health advocates hoped to get a major bill during the new administration's first 100 days. Now, it looks like it will take longer, and some observers fear that a historic opportunity could be missed. The economic downturn—which some say highlighted the burden of rising health care costs on businesses—has worsened to the point where deficit projections are already beyond $1 trillion. The stimulus bill and financial bailout are devouring the fledgling administration's political energy and kicking up considerable partisanship in Congress.

Democrats Among Stimulus Skeptics
Washington Post, 1/28/09
The Post examined how some supporters of Obama and Democrats have raised concerns that the economic stimulus package might "fall short in its broader goal" of "laying the groundwork for overhauls" of health care and other areas. For example, as part of an effort to "address Obama's longer-term goals" for health care reform, the stimulus package includes $20 billion of a total of $50 billion in funds that he seeks to invest in health care I.T., which he has said would reduce costs, according to the Post. However, health care experts "worry that the pressure to spend it fast for stimulus reasons could keep the new network from being implemented as effectively as it needs to be to reduce costs," the Post reports.

Stimulus Bill Near $900 Billion
Wall Street Journal, 1/28/09
The U.S. economic stimulus package neared $900 billion in the Senate, as President Barack Obama wooed Republicans ahead of an expected House vote. The economic stimulus package proposed by Democratic House leaders totals $825 billion and includes three broad pieces: a $365.6 billion spending measure for such brick-and-mortar projects as highways and bridges; a $180 billion measure to boost jobless benefits and Medicaid, among other things; and a $275 billion tax-relief package, which includes a plan to give a $500 payroll tax holiday to all workers, a proposal from Mr. Obama's presidential campaign.

Senate Committees Mark-up Health I.T. Stimulus Package
Government Health IT, 1/28/09
Appropriations and Finance panels confer on language covering Medicare and Medicaid funding, domestic content, and regulating privacy of personal health records. The stimulus package carrying billions of dollars for health I.T. continued its fast track through Congress with both the Senate Appropriations Committee and the Senate Finance Committee passing parts of the bill. The Appropriations committee offered just a few amendments to the bill as originally written by Democrats, which includes $5 billion for health I.T. The Finance Committee passed on mostly party-line votes a package that includes $17.9 billion for health I.T.

Electronic Health Records: The Time is Now
PR Newswire, 1/28/09
HIMSS announced its support for the health information technology (HIT) provisions in the American Recovery and Reinvestment Plan of 2009 proposed by Congress. HIMSS believes the inclusion of funding for HIT is essential if we are to meet President Obama's goal of computerized health records for all Americans by 2014.

Advocacy Group Alleges Google Lobbying To Sell Data in Health Records
ihealthbeat.org, 1/28/09
Consumer Watchdog is urging Google to end a rumored lobbying effort aimed at allowing the sale of data included in electronic health records in the economic stimulus legislation under consideration in Congress. Google allegedly is pushing for provisions that would allow it to sell patient information from its Google Health database to advertising clients. The not-for-profit consumer education and advocacy group also is urging Congress to remove loopholes in the ban on the sale of information stored in medical records and to include other privacy protections in the economic stimulus package.

House Passes Stimulus Plan Despite GOP Opposition
New York Times, 1/29/09
Without a single Republican vote, President Obama won House approval on Wednesday for an $819 billion economic recovery plan as Congressional Democrats sought to temper their own differences over the enormous package of tax cuts and spending. As a piece of legislation, the two-year package is among the biggest in history. But the size and substance of the stimulus package remain in dispute, as House Republicans argued that it tilted heavily toward new spending instead of tax cuts.

Buy American’ I.T. Provision Cut from Stimulus Bill
Modern Healthcare, subscription needed 1/29/09
Legislative provisions that would require providers to use federal health information technology funds to purchase equipment made in America were stripped from both the House and Senate versions of a massive $819 billion economic stimulus package, riling Republican lawmakers who say they want assurances that taxpayer dollars stay in country.

Rep. Kennedy Plans To Reintroduce PHR Incentive Legislation
iHealthbeat, 1/29/09
Rep. Patrick Kennedy (D-R.I.) said he plans to reintroduce a bill that would create a trust fund to pay physicians a few dollars for each patient who creates a personal health record. Kennedy, co-chair of the House 21st Century Health Care Caucus, said he would introduce the legislation after the House completes its work on the economic stimulus plan and addresses the fiscal year 2009 omnibus appropriations bill.

Waxman: ‘I’m committed’ to Health Reform in 2009
The Hill, 1/29/09
Democrats will advance a major health reform bill before the end of the year, House Energy and Commerce Committee Chairman Henry Waxman (D-Calif.) affirmed. “We need to get this job accomplished this year and get the bill to the president,” Waxman said. Faced with gargantuan economic problems and myriad other priorities, President Obama and key Democrats in the House and Senate maintain that they can succeed in the arduous task of enacting a comprehensive overhaul of the U.S. health care system. “We don’t intend to let delay sap the opportunity to finally enact the legislation we’ve waited decades for. The situation is too critical. The need is too great,” Waxman said.

Hospital Association Praises House Passage of Stimulus Bill
Modern Healthcare, subscription needed 1/29/09
Despite Republican opposition, lawmakers in the House passed a massive legislative package aimed at creating and retaining jobs in the U.S., but which also shores up safety net health care programs and allots billions of dollars to help spur the adoption of health information technology. Rick Pollack, executive vice president of the American Hospital Association, called passage of the House bill “a good first step,” but added that there are other provisions lawmakers should consider. Smaller hospitals, with fewer than 25 beds, should have better access to the health I.T. funding, he said in an e-mail. “We also call on Congress to ensure the temporary funding increase in the federal Medicaid match is used to maintain current benefits and provider payments,” he added.

Stimulus Package Brings Out Wide Range of Privacy Opinions
iHealthBeat, 1/30/09
The debate over health I.T. privacy standards has cranked up a notch as Congress considers the economic stimulus package. The opinions on medical privacy in the digital age range from those who contend data should be released only with the informed consent of the patient to those who consider the notion of privacy an antiquated, no-longer-relevant idea. Meanwhile, industry watchers said Google is working Capitol Hill in an effort to tone down or eliminate proposed language governing the sale of medical information.

$800B Plan Full of Spending: Unlikely to Spur Jobs
Orlando Sentinel, 1/31/09
They call it "stimulus" legislation, but the economic measures racing through Congress would devote tens of billions of dollars to causes that have little to do with jolting the country out of recession. There's $345 million for Agriculture Department computers, $650 million for TV converter boxes, $15 billion for college scholarships— worthy, perhaps, but not likely to put many Americans back to work quickly. Yes, there are many billions of dollars in "ready-to-go" job-creating projects in President Barack Obama's economic-stimulus bill. But there are also plenty of items that are just unfinished business for Congress' old bulls. An $800 billion-plus package, it turns out, gives lawmakers plenty of opportunities to rid themselves of nagging headaches left over from the days when running up the government's $10 trillion-plus debt was a bigger concern.

A Stimulus Plan With Dual Goals: Reform and Recovery
New York Times, 1/31/09
As President Obama and Congress barrel toward the latest emergency program to resuscitate the American economy, one question is looming over their search for a cure: Can the government fashion a fast and efficient economic stimulus while also seizing the moment to remake America? For now, Mr. Obama and his aides are insisting they can accomplish both goals, following their mantra of using the urgency of the economic crisis to accomplish larger—and long-delayed—reforms that never garnered sufficient votes in ordinary times.

Your E-Health Records (Editorial)
New York Times, 1/31/09
As part of the stimulus package, $20 billion will be pumped into the health care system to accelerate the use of electronic health records. The goal is both to improve the quality and lower the costs of care by replacing cumbersome paper records with electronic records that can be easily stored and swiftly transmitted. With paper records the opportunities for breaches are limited to over-the-shoulder glimpses or the occasional lost or stolen files. But when records are kept and transferred electronically, the potential for abuse can become as vast as the Internet.

Stimulus Package: Big Money, Huge Plans
Chicago Tribune, 2/1/09
With Congress moving toward passage of an $800 billion-plus economic stimulus plan, big government is back. The stimulus is bigger than the Pentagon's entire budget. It's more than the U.S. has spent on the war in Iraq. And its hundreds of provisions reach into almost every aspect of American life. Not since the Great Depression has Congress set out to expand and redefine so dramatically the government's role in the economy. If the stimulus plan succeeds, it's likely to mean a larger, more activist government for years to come. If it is judged a failure—whether because the economic crisis persists or the public becomes disenchanted—the idea of government as an active player in national life could be discredited anew.

Cost of Obama e-Health Plan Could Reach $100B
Computerworld, 2/2/09
A national electronic health records system remains a first-term priority for President Barack Obama, but its price tag may far exceed current estimates. During his campaign, Obama pledged to invest $10 billion per year over the next five years on an EHRs program which would be designed to streamline workflow at hospitals, clinics, and physician offices. Some experts said that Obama's initial estimates of the cost and time of implementation are likely far below what will be needed to create and roll out an EHR system across the U.S. Many said the price tag could be closer to $100 billion and implementation could take up to 10 years. The ONC has had some success in getting state and local governments to support the creation of RHIOs. To date, 66 RHIOs have been created in the U.S., and many of them are now working to create EHRs. Massachusetts is one of 30 states which introduced or passed legislation calling for the statewide adoption of standardized health I.T. systems. Under a law enacted last summer, Massachusetts wants 14,000 private physicians' offices to adopt EHR systems by 2012, and its 63 hospitals by 2014.

Democrats Set High Goal Of Sweeping Fiscal Reform
Washington Post, 2/2/09
It's the holy grail of Washington politics: a federal budget that generates ample funds through a simpler and fairer tax code, defuses the spending time bomb for health and retirement programs, and supports the nation's economy during the worst downturn in generations. The Senate opens debate on a nearly $900 billion plan to pull the nation out of recession. If passed, it would send this year's budget deficit—the annual gap between spending and income—soaring toward a record $1.4 trillion, or nearly 10 percent of overall economic output, a level not seen since the end of World War II. The growing gap is rapidly driving up the national debt, causing lawmakers and budget experts to fret that the nation could be overwhelmed by mounting interest payments to private creditors even as it struggles to cover the skyrocketing cost of caring for retiring baby boomers.

Privacy Advocates Hail Stimulus Bills
Government Health IT, 2/2/09
As Congress gets ready to pass the economic stimulus bill, health privacy advocates find themselves in an unaccustomed position: the driver’s seat. The privacy language in the health I.T. section of the Senate bill resembles that of the House bill. That suggests there will not be much opportunity to modify it before the legislation becomes final and goes to President Barack Obama for his signature.




A Giant Battle Over Medicaid is Brewing in Minnesota
Minneapolis Star Tribune, 1/27/09
As Gov. Tim Pawlenty tackles Minnesota's epic budget deficit this year, he faces the huge dilemma with Medicaid. The federal-state health insurance program for the poor, elderly and disabled is growing at a frightening pace in every state. But cutting it could end up costing Minnesota more in lost federal revenue. Moreover, Pawlenty is up against those in the Legislature who want to expand health care coverage for the poor. In Minnesota, the state government's $3 billion half of the Medicaid bill represents about one-fifth of its annual budget. That's expected to rise by 12% in each of the next two years.

States Take Aim At Medicaid
Wall Street Journal, 1/28/09
At least 25 states have enacted or proposed cuts in health-insurance programs for the poor, potentially leaving millions of patients with reduced levels of care or no coverage at all. The cuts come as states are making painful moves to close record budget deficits while facing increased demand for services. Across the country, states have pared services under Medicaid and 12 states have also targeted the State Children's Health Insurance Program, a federal-state program designed to provide health care for children from low-income families that earn too much to qualify for Medicaid, said a report by Families USA, an advocacy group in Washington. The group estimates that more than 250,000 people will lose care because of cuts already enacted and proposed cuts could affect millions more.

More Relying on State Health Care Programs
Journal Sentinel, 1/29/09
Enrollment in state health care programs such as BadgerCare Plus has increased by about 238,000 people—or 35%—in the past six years and is expected to rise as the economy continues to struggle. Medicaid programs provide some level of health care to about 1 in 6 Wisconsin residents. How to fund the $5 billion-a-year program —which faces a deficit of about $1.4 billion through the next two-year budget—is one of the biggest long-term questions looming for the state. State leaders will likely get help for this budget from the federal stimulus package being developed in Washington.

Kaiser Daily Health Policy Report Highlights Recent Budget News in Three States
kaisernetwork.com, 1/30/09
In Maine, the state Legislature approved a $166 million supplemental budget that includes $34 million in cuts to health care programs, the Capital News Service/Bangor Daily News reports. Under the supplemental spending plan, payments to physicians working in hospitals will be cut by $1.7 million. The budget also includes a provision that prioritizes settlement payments to Maine hospitals for bills they are owed when expected federal Medicaid funds in the economic stimulus bill are distributed.

In Massachusetts, Gov. Deval Patrick (D) released a $28 billion state budget proposal for fiscal year 2010 that freezes Medicaid reimbursement rates for physicians and hospitals and cuts funding to several public health programs, the Boston Globe reports. The budget also would eliminate a $3.5 million program that helps uninsured residents enroll in health coverage. The budget proposal also would place new levies on alcohol, candy and sweetened beverages to generate an estimated $121.5 million for public health initiatives, according to the administration.

Stimulus Bill Would Give State $11 Billion
Boston Globe, 1/30/09
Massachusetts would receive at least $6.5 billion in federal aid during the next two years under the economic stimulus bill passed by the US House. The bill would save or create 94,560 jobs in Massachusetts. The payout to Massachusetts will almost certainly change again when the Senate takes up the $819 billion package next week. Also, the precise impact of the recovery plan on each state is difficult to gauge because of variations in funding formulas that rely on population, unemployment, poverty, and other factors. But if a bill similar to that passed by the House becomes law, state government, cities and towns, and residents of Massachusetts would receive at least $11 billion, most of it over the next two years, according to the Center for American Progress, an advocacy group that supported the bill. The bill's biggest direct benefits to state government include $2.1 billion for Medicaid, $1.3 billion for a "fiscal stabilization fund" that would help reduce the state's deficit, and more than $500 million in extra funding for education.

Once Immune from Recessions, the Industry Finds Itself Ailing as People Forgo Doctor Visits
Star Tribune, 2/1/09
An industry that sailed through the last two recessions is hitting the shoals this time. Local [Minnesota] hospitals have shed more than 1,000 workers since last year and postponed big construction projects. The University of Minnesota Medical School is "looking under every stone'' for savings. State nursing homes are bracing for millions of dollars in cuts proposed by Gov. Tim Pawlenty.

N.J. Stands to Get Vast Boost from Stimulus
The Star-Ledger, 2/1/09
Michael Rothkopf, a West Orange doctor, has been lobbying state and federal officials for years to put more health records on-line. So he looks at the economic stimulus package passed by the House and about to be debated in the Senate not as some amorphous blob of money but as a sign that change is coming. The bill the House approved includes $20 billion to modernize health records nationwide, which would save money through reduced paperwork, and make it much easier for patients to obtain their records, through secure Web sites. It also would pour money into companies that provide the computers, software, and training. In New Jersey, it could mean millions of dollars in grants of anywhere from $40,000 to $60,000 to doctors who want to digitize patient data. The electronic health grants are one tiny piece of the estimated $4.3 billion that could flow into New Jersey under the stimulus plan. With the measure nearly halfway to the finish line, New Jersey officials are celebrating their good fortune and lobbying hard to maintain their share in the Senate's version.

California Health Care Funding Differs by $1.5 Billion in House, Senate Stimulus Plans
Los Angeles Times, 2/2/09
For California, the question of how much medical aid states will get under the economic stimulus plan is a billion-dollar one, and it has revived a debate over whether the Golden State receives its fair share of federal dollars. The House version of the bill would give financially strapped California about $11.1 billion in Medicaid funds to help pay for health care for the poor, according to the Washington-based Center on Budget and Policy Priorities. The measure the Senate will take up would provide about $9.6 billion.

New Mexico Considers New Electronic Medical Records Law
New Mexico Health Department, 2/2/09
The New Mexico Legislature is considering an electronic medical record initiative of Governor Bill Richardson's that would protect patients' privacy. Sen. Peter Wirth introduced SB 278, the Electronic Medical Records Act that would require security and privacy protections associated with the use of electronic medical records. Governor Richardson has supported moving from paper to electronic records during his administration as a way to control costs, reduce errors, and increase quality. The Electronic Medical Records Act would allow individuals to request that their records be excluded from a record locator service and that the service provide a log indicating who has accessed a client's medical record and for what purpose. The act would also establish electronic medical records systems as the legal equivalent of existing non-electronic medical records. The New Mexico Department of Health is now using electronic medical records in all public health offices around the state.




Medicare-Payment Fix Weighed
Wall Street Journal, 1/29/09
As leaders in Congress and the Obama administration look to expand health-insurance coverage while controlling costs, they are considering changing the way doctors are paid for treating patients covered by Medicare. Critics of the current system, in which most doctors are paid for each procedure they perform, say it creates a financial incentive for unnecessary treatments. Alternatives such as paying a fixed annual rate for each patient have been criticized for giving providers an incentive to withhold potentially helpful treatments. In search of a middle road, policy makers and some private insurers may opt to make a single, blanket payment for such things as implanting an artificial hip or providing a few months of cancer treatment, which currently can involve many separate billable procedures.

Barriers Remain to DOD/VA Sharing
Health Data Management, 1/30/09
The Departments of Defense and Veterans Affairs face challenges in meeting a Sept. 30, 2009, deadline for making their health information systems interoperable, according to the Government Accountability Office, an investigatory arm of Congress. Gradual progress continues to be made in exchanging data between the systems. For instance, the departments now are exchanging pharmacy and allergy data on more than 21,000 shared patients.

Kolodner Could Keep Position of National Health I.T. Chief
ihealthbeat.org, 1/30/09
Robert Kolodner might continue to serve as National Coordinator for Health I.T. under the Obama administration. In a blog posting, Bob Brewin, editor-at-large for NextGov.com, wrote that Kolodner told him he would continue to head the Office of National Coordinator for Health I.T. under the Obama administration. Kolodner became the interim head of ONC in mid-2006, replacing David Brailer, the first national coordinator for health I.T.. Kolodner later was named the office's permanent leader. ONC spokesperson Nancy Szemraj would neither confirm nor deny that Kolodner would stay in his position.

Wisconsin Health Care Groups Turn to Telehealth Technology
Milwaukee Journal Sentinel, 1/31/09
The use of telehealth technology to monitor patients remotely is increasing in Wisconsin. Some of the health care groups using telehealth technology in Wisconsin include Aurora Visiting Nurse Association, ThedaCare, and Wheaton Franciscan Healthcare. The technology has the potential to improve care and save funds by decreasing hospitalizations, visits to the emergency department and home health visits. However, the biggest barrier to widespread use of the technology is that Medicare and most private health plans do not reimburse for the service.

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