By the Associated Press

President Barack Obama, faced with falling approval ratings and increasingly impatient with Senate negotiations over health care, is weighing a shift in strategy that would offer more details of his goals for overhauling the nation’s healthcare system.

The president is considering a speech in the next week or so in which he would be “more prescriptive” about what he feels Congress must include in a bill, top adviser David Axelrod said Tuesday in an interview. The speech might occur before the Sept. 15 deadline the White House gave to Senate negotiators to seek a bipartisan bill, Axelrod said. He suggested that two key Republicans have not bargained in good faith.

Congress reconvenes next Tuesday after an August recess in which critics of Obama’s health proposals dominated many public forums.

Some Obama allies, watching his approval ratings tumble in polls along with support for a healthcare overhaul, have urged the president to take a more hands-on approach. They feel he gave too much leeway to Congress, where one bill has passed three House committees, another has passed a Senate committee and a third has been bogged down in protracted negotiations in the Senate Finance Committee.

Axelrod indicated that Obama would not offer new proposals but would be more specific about his top priorities.

“The ideas are all there on the table,” Axelrod said. “Now we are in a new phase, and it’s time to pull the strands of these together.”

He said there is serious discussion in the White House of Obama “giving a speech that lays out in specific ways what he thinks” about the essential elements of a healthcare bill.

Axelrod said it was possible that the speech could occur before a planned Sept. 15 Obama address on healthcare in Pittsburgh.

Obama has called for innovations such as a public health insurance plan to compete with private insurers, but he has not insisted on it. It was not clear Tuesday the degree to which he might press for various proposals in a new speech.

Obama also plans to meet with Democratic congressional leaders on Tuesday.

Above article published on

http://www.modernhealthcare.com/article/20090902/REG/309029973/-

By Neil Versel

Dr. David Blumenthal, the national coordinator for health information technology, gave a strong indication of how HHS ultimately will define “meaningful use,” the standard that providers must meet to be eligible for Medicare and Medicaid EMR bonuses, by warning that hospitals unwilling to share data with others risk being shut out of the stimulus funding. “There’s a fair amount of money in the law for hospitals that adopt interoperability,” the Dallas Morning News quotes Blumenthal as saying. “If they don’t, they’re not likely to be eligible for payment.”

Although the three largest hospital operators in the Dallas-Fort Worth are implementing EMRs, there is no means for health information exchange between the systems or with smaller providers. The Dallas-Fort Worth Hospital Council is only now working on an HIE feasibility study, and is seeking grant funding to lay the groundwork for data sharing, the newspaper reports.

In McAllen, TX, recently named the second-most-expensive healthcare market in the country, one physician executive believes that interoperability could help rein in some of the spending.

Let me know for further assistance.

http://www.fierceemr.com/story/blumenthal-must-share-data-get-stimulus-money/2009-06-25

By Neil Versel

Vice President Joe Biden, HHS Secretary Kathleen Sebelius and national health IT coordinator Dr. David Blumenthal are in Chicago today to announce $1.2 billion in federal grants to promote EMR use and interoperability. The money represents the bulk of the $2 billion in stimulus funds allocated to the Office of the National Coordinator for Health Information Technology.

Of the $1.2 billion, the administration plans to spend $589 million on health IT extension centers to assist hospitals physician practices in selecting and implementing EMRs. The other $564 million will go to encourage health information exchanges and help build the Nationwide Health Information Network. “Electronic health records can help reduce medical errors, make healthcare more efficient and improve the quality of medical care for all Americans. These grants will help ensure more doctors and hospitals have the tools they need to use this critical technology,” Sebelius says.

The administration officials are speaking at Mount Sinai Hospital, an aging facility in an impoverished West Side neighborhood, where just 7 percent of patients have commercial insurance. Biden is leading a roundtable discussion on comprehensive healthcare reform, focusing, in part, on health IT infrastructure, his office says.

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http://www.fierceemr.com/story/biden-sebelius-blumenthal-announce-funding-emr-extension-centers-hie/2009-08-20

By Anne Zieger

The Agency for Healthcare Research and Quality has announced that it will provide a series of grants totaling $48 million that can be used to develop national patient registries for comparative effectiveness research. Clinical registries are one of a number of approaches to helping providers identify the long-term effects of treatments, along with clinical data networks and other forms of health IT networking.

This is part of a larger $300 million grant and contract package designed to fund comparative effectiveness projects funded by the federal stimulus package. The AHRQ will offer grants to study treatment benefits focused on 14 common conditions, including diabetes, obesity and heart and blood vessel problems.

AHRQ will also seek $74 million in contracts for analyzing and generating evidence, along with $19.5 million to establish an infrastructure for identifying the right treatment issues to focus on as part of comparative effectiveness reviews.

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http://www.fiercehealthit.com/story/ahrq-handing-out-48m-grants-comparative-effectiveness-research/2009-08-16

DENIS STAUNTON in Washington

US PRESIDENT Barack Obama has promised to overhaul the American healthcare system by the end of this year – without Republican support if necessary.

Speaking in Indiana after a town hall meeting to promote his economic policies, the president said he would prefer to sign a bipartisan healthcare Bill but it was not yet clear if negotiations with Republicans would prove fruitful.

“Sometime in September we’re going to have to make an assessment,” he told MSNBC. “I promise you, we will pass reform by the end of this year because the American people need it.”

Mr Obama told his audience in Elkhart, which experienced the sharpest unemployment rise in the US last year, that he would issue $2.4 billion in taxpayer grants to create electric cars and tens of thousands of jobs.

“For too long, we failed to invest in this kind of innovative work, even as countries like China and Japan were racing ahead,” he said.

“That’s why this announcement is so important – this represents the largest investment in this kind of technology in American history.”

Mr Obama identified energy, innovation, healthcare and education as the pillars of the new US economy he wants to build from the wreckage of the recession.

“Now, there are a lot of people out there who are looking to defend the status quo. There are those who want to seek political advantage. They want to oppose these efforts.

“Some of them caused the problems that we got now in the first place, and then suddenly they’re blaming other folks for it. They don’t want to be constructive. They don’t want to be constructive; they just want to get in the usual political fights back and forth,” he said to applause.

“But you and I know the truth. We know that even in the hardest times, against the toughest odds, we have never surrendered. We don’t give up. We don’t surrender our fates to chance. We have always endured. We have worked hard, and we have fought for our future.

“Our parents had to fight for their future; our grandparents had to fight for their future. That’s the tradition of America.

“This country wasn’t built just by griping and complaining. It was built by hard work and taking risks. And that’s what we have to do today.”

Republicans, who have opposed all Mr Obama’s key proposals, from the economic stimulus package to healthcare reform, see in the president’s declining popularity an opportunity to make gains in next year’s congressional elections.

“President Obama is now looking like a mere mortal, as opposed to someone who previously exceeded gravity,” said John Cornyn, chairman of the National Republican Senatorial Committee.

“I think there will be a significant number of voters who, leading up to 2010, will wonder if they voted for someone they didn’t get.”

Above article published on

http://www.irishtimes.com/newspaper/world/2009/0806/1224252080737.html

By JANE ZHANG

Federal health agencies, seeking to hand out stimulus funds to research the effectiveness of various medical treatments, said they will include projects that look in part at the cost of drugs and other treatments.

The approach — which was unveiled in a report to Congress this week by the Agency for Healthcare Research and Quality and the National Institutes of Health, both agencies under the Department of Health and Human Services — could provide more fodder to conservatives worried that the government might use the results of such studies to limit health care to consumers.

Administration officials have said they want to use stimulus funds to help doctors and patients choose more-effective treatments and ultimately, help rein in rising health-care costs. Democrats are considering including measures that would support such research as part of health-care legislation making its way through Congress.

The Agency for Healthcare Research and Quality, which has $300 million to spend on comparative research, mostly in the fiscal year starting Oct. 1, said it would increase funding to projects that focus on arthritis, cancer and 12 other conditions that are often costly to treat.

“This is unprecedented investment in helping clinicians and patients identify what’s the best for them in treatment,” said Carolyn Clancy, the agency’s director, in an interview.

The NIH, which is earmarked to spend $400 million in comparative-treatment studies over two years, will fund projects that include cost as a factor in their studies, said Richard J. Hodes, director of the NIH’s National Institute on Aging.

The NIH has received 1,800 research applications, but hasn’t figured out how many fall under the definition of “comparative effectiveness research,” Dr. Hodes said. The agency will award the first grants in August.

The two agencies don’t set policy, but their work helped officials running government programs such as Medicare, the insurance program for the elderly and disabled, decide which treatments to cover. Nicholas Papas, an HHS spokesman, said under the stimulus law, Medicare can’t use the research to deny coverage to patients.

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http://online.wsj.com/article/SB124907957435498005.html

As President Obama continued his push to reform the U.S. health care system, he highlighted the Cleveland Clinic as a model for how effective health IT systems can improve care and lower costs, Healthcare IT News reports.

Obama visited the Cleveland Clinic on Thursday and viewed a presentation on the center’s health IT initiatives.

Cleveland Clinic executives also spoke with the president about patient-centered health IT projects involving Microsoft HealthVault, Google Health and MyChart. MyChart currently connects 202,000 patients to an online portal for appointment scheduling, prescription management, preventive health reminders and test results.

C. Martin Harris, Cleveland Clinic’s CIO and a member of HHS’ Health IT Standards Committee, said the center “is developing health IT that gives patients the power to better manage their health care.”

Harris added that the Cleveland Clinic is “focused on helping lead the nation toward a comprehensive electronic medical records system that will reduce medical errors, improve quality and lower costs.”

During a town-hall meeting later that day, Obama said the Cleveland Clinic has “one of the best health IT systems in the country.” He said the center’s electronic health technology allows it to:

• Boost patient care;
• Coordinate with other health workers in the community;
• Improve chronic disease management;
• Monitor treatment efficacy;
• Reduce duplicate testing; and
• Track patient health and progress.

Obama said, “And here’s the remarkable thing: They actually have some of the lowest costs for the best care” (Monegain, Healthcare IT News, 7/24).

Ezekiel Emanuel, a physician and health policy adviser to the Obama administration, said the Cleveland Clinic has a “fantastic health IT system, which is a necessary component of changing the game” in health care reform (Brown, Washington Post, 7/23).

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http://www.ihealthbeat.org/Articles/2009/7/24/Obama-Continues
-To-Tout-Health-IT-as-a-Key-to-Health-Reform.aspx

Pulmonary Care of Central Florida is installing a new electronic medical records system — a move that may help it land some of the $19 billion in federal stimulus funds earmarked for health information technology.

The Winter Park medical group, which has one doctor and two nurse practitioners, decided to do so to reduce the amount of space needed for records storage and to save time, said MaryAnn Simmons, the practice’s administrator.

She estimated such systems cost $50,000-$70,000, take about a month to install and up to eight months to master.

It’s unknown how many local doctors use electronic medical records, but Melanie Boscan, executive director of the Orange County Medical Society, estimated at least 20 percent have them — and the rest may be waiting to see how the federal stimulus incentives shake out. “Doctors are a little leery. Until they are all mandated to have a system, you’re not going to see a rush.”

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http://orlando.bizjournals.com/orlando/stories/2009/06/29/story8.html

By KRISTEN WYATT
ASSOCIATED PRESS WRITER

COLORADO SPRINGS, Colo. — Homeless teenagers at a central Colorado shelter are feeling the effect of the government’s economic stimulus package. It’s the feeling of a dentist’s drill.

The 20 runaway youths living at the Urban Peak shelter had no regular dental care until this spring, when a $1.3 million stimulus grant to a community health center paid for a mobile dental and medical clinic to visit once a month. The residents now get medical and dental screenings, and cavities filled, right from their shelter’s parking lot.

“I knew my teeth needed to be fixed but I had no money,” says Michelle Daulton, 18, who has been living at the shelter for about four months and hadn’t seen a dentist since she was 13.

Now she’s had three chipped teeth repaired. “It was absolute and pure relief, I mean that,” she said.

From the Colorado homeless shelter to rural Pennsylvania clinics that can accept new patients, health centers that serve the poor are among the first places the federal stimulus package is being spent.

The stimulus law sets aside $2.5 billion for free and low-cost health clinics, and a big chunk of it - about $500 million - is already being spent. The White House has promised another burst of money this summer.

“This has really been a boost for us,” said Bob DeFelice, CEO of First Choice Community Health Care. “It’s allowed a level of stability in some very difficult times.” DeFelice’s group runs nine community health clinics around Albuquerque, N.M., and used a $703,000 grant to hire two physicians and four support staffers.

Health clinic executives say the money will allow them to keep their doors open as the rolls of uninsured patients grow. An estimated 64 million people use rural health clinics, a number that is expected to rise as people lose their jobs and health insurance.

“We’re seeing more and more people,” said Edward Michael, president of the Rural Health Corp. in Wilkes-Barre, Pa. The six-clinic group in northeastern Pennsylvania had no room for new patients until it received a $311,000 grant in April. Now, Michael says, his clinics can expand from seeing 18,000 patients last year to 19,000 this year.

“You know, we weren’t there back in the Depression, so we never experienced being back in the ’30s standing in line for food, standing in line for a doctor,” Michael said. “This money is really going to prevent a lot of long-term hardship.”

The health clinic grants are one-time boosts, not long term health care fixes. The stimulus won’t make up for a lack of doctors in poor and rural areas, a shortage the Association of American Medical Colleges says is growing and could reach 159,000 doctors by 2025.

“I look at the stimulus bill as one step to health care reform,” said Maggie Elehwany, vice president for government affairs and policy at the Washington-based National Rural Health Association. “It isn’t everything.”

While Congress considers a health care overhaul, clinic workers hope just to keep up with basic needs such as vaccinations and exams.

“I can’t imagine not having the stimulus money right now because we wouldn’t be able to do any of this,” said Nicole Noll, who drives the mobile health clinic to the teen homeless shelter and rural elementary schools.

The van was provided by Ronald McDonald House Charities. But stimulus money pays for Noll, the doctors and the dentists.

Far more than a brighter smile can be at stake in dentistry. In Maryland, a 12-year-old boy whose Medicaid coverage had lapsed, Deamonte Driver, died in 2007 after bacteria from the abscess of an aching tooth spread to his brain. An $80 tooth extraction might have saved his life.

“I’m so glad they did this,” Michelle Daulton said. “My parents were cheap. They never took me to the dentist. And when you don’t have any money, your teeth, you just leave ‘em alone. Not anymore.”

Above article published on

http://www.seattlepi.com/national/1110ap_stimulus_health_clinics.html

The Healthcare Information and Management Systems Society predicts that hospitals will spend $14.4 billion on IT systems through 2014 but that capital spending will remain relatively flat until funding from the federal stimulus package kicks in, Government Health IT reports.

On Tuesday, HIMSS officials discussed their hospital health IT spending projections, which are based on the group’s tracking of more than 5,000 U.S. hospitals.

According to HIMSS, spending on systems — such as electronic health records, computerized physician order entry and clinical decision support — is expected to reach $1.7 billion this year. Hospitals’ IT spending later will increase because of the effect of the federal stimulus package, HIMSS predicts.

Funding Constraints

Mike Davis, executive vice president of HIMSS Analytics, said that hospitals face funding challenges in the near term.

He said that banks are not lending to the hospitals he has talked to, including those that have submitted business plans based on the federal stimulus package. He added that hospital endowment funds have lost 20% to 30% of their value in some cases.

Davis said he hopes to see signs of improvement by the end of the year.

Davis also noted that some IT vendors have begun to offer financial assistance to hospitals. For example, GE announced earlier this week that it plans to offer interest-free loans to hospitals and health care providers, he said.

Conflicting Priorities

Davis said that as funding becomes more available, hospitals will face conflicting investment priorities.

He said that as hospitals continue to pursue EHR projects, they face a January 2012 compliance deadline for HIPAA 5101 transactions and an October 2013 deadline for ICD-10 coding compliance (Moore, Government Health IT, 6/17).

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http://www.ihealthbeat.org/Articles/2009/6/18/Hospitals-To-Spend-14B-on
-Health-IT-Through-2014-HIMSS-Says.aspx