Congressional Budget Office Weighs In On Obama’s Health Care Proposals

Yesterday, the Congressional Budget Office released its report on the Obama health plan:

Claiming back some of the rewards given to doctors for improving productivity could save the government Medicare program up to $201 billion over the next 10 years, a congressional analysis showed on Thursday.

The move, which could pressure healthcare providers to find new ways to improve productivity, would produce greater savings than adopting medical information technology, as advocated by President-elect Barack Obama, or capping medical lawsuit awards, as favored by some Republicans, the study showed.

The productivity option was one of 115 examined by the nonpartisan Congressional Budget Office in its 235-page “Budget Options, Volume 1: Health Care,” released on Thursday. The CBO does not offer recommendations.

Better record keeping and a move to pay-for-performance could result in increased savings. Improved productivity seems like the obvious choice, but at least we are talking about it. Could this finally be the beginning of a true Health IT push? What is interesting here from a social media perspective is what you can find on the CBO Director’s Blog:

Serious concerns exist about the efficiency of the health care system, but no simple solutions are available to reduce the level or control the growth of health care costs. Steps to restructure the insurance market and to encourage people to purchase less extensive coverage could reduce the use of treatments that provide minimal benefits, but enrollees would face higher cost sharing or tighter management of their care.

Other approaches—such as the wider adoption of health information technology or greater use of preventive medical care—could improve people’s health but would probably generate either modest reductions in the overall costs of health care or increases in such spending within a 10-year budgetary window.

That sounds like good news for HIT and for patient safety. The “serious concerns” statement should make us all sit-up and take notice. I beileve it is time for our indusitry to recognize the need for change on a broad scale and start to work on solutions from within the industry. While I’m optimistic about Federal reform, I’m just not 100% confident that more governement intervention is really in the best intrest of our industry in the long run.

Tags: Healthcare, Healthcare IT, Obama

Webcast: Healthcare 2015: The Impact of the Obama Presidency

Today, I attended the webcast called “Healthcare 2015: The Impact of the Obama Presidency” presented by IBM. The presenters included:

• Dr. Peter Budetti, MD, JD Chair, Department of Health Administration and Policy, University of Oklahoma Health Sciences Center
• Dr. Paul Grundy, MD, Director of Healthcare Transformation, IBM Healthcare and Life Sciences
• Mr. Len Nichols, Director, Health Policy Program, The New America Foundation

Dr. Budetti began the presentation pointing out the differences in the 1993 healthcare efforts and the present situation. For example, in 2009 the White House will have staff with more experience working with congress and there is a stronger commitment on both sides to work together. This time the major medical groups are supporting universal coverage where it was fought in 1993. Another key difference is the engagement of the end users of health reform, creating the site change.gov to solicit input on change.

Here is another example of the role of social media and online communications. The tools that help get Obama elected are not being turned to resolve issues in healthcare. Once again, healthcare institutions and providers who are not involved in the social media space are completely missing the boat.

The key message I heard from Dr. Budetti was, the government is asking for involvement from a better-educated consumer who is more engaged and prepared for change then in 1993. The result, new business opportunities are on the horizon for those who are paying attention.

Len Nicholas agreed with the general sense of Dr. Budetti’s presentation, but had more reserve in his talk. He stressed the need to focus on infrastructure for health. He also believes President-Elect Obama has recognized the importance of speaking with one voice on healthcare reform and the voice will be Tom Daschle.

Nicholas stated health information technology grants and loans will be part of the new stimulus package and the focus may be on outcomes. He indicated the most exciting news of what is happening on the Hill is a ground swell of effort to talk about medical effectiveness and spread the sharing of best practices in medicine, the expansion of the medical home, and a move away from fee for services and toward a fee for outcomes or pay for performance.

Personally, I think this type of change may be a ways in the future, but it is definitely needed. The first step has to be creating of common containers and protocols that will allow for outcomes study and measure to be established. One cannot argue the need for these types of systems when you consider the number of patients who are injured or die from bad medical information.

What did the presenters think of the prospect for economic recovery and its impact? Our economy is in uncharted water, there is a reasonable expectation of recovery by mid-2009 early-2010, but there are no guarantees. If the downturn continues, all could be out the window.

The economic recovery a component of health reform, but Nichols stated that bipartisan support and involvement might be the key to long-term change. He indicated that a lot of the Obama’s campaign rhetoric was based on cost savings that are not realistic and the realization of that fact will have an impact on the healthcare debate. As of now, he believes the Republican strategy is still unclear and evolving and will key on the activities of individuals like Senators Grassley and Gregg.

The two issues affecting bipartisan support are:

1. Building a public insurance plan to compete against private insurance. The plan could be something like Medicare which would not be supported by Republicans or more like state employee plans which would garner more bipartisan support.
2. The role of the employer in the insurer model will also elicit strong reactions from both sides of the isle.

At the end of the day, unlike 1993, there is a feeling of strong bipartisan support for health reform and the presenters believe the legislative committees will be authoring the bills. That should mean greater support from Congress.

Why will Daschle be more effective this time? He was part of the Clinton healthcare team in the 90s and profoundly impacted by the failure of that effort. Daschle saw that the failure to cooperate was the cause of the downfall and the reform effort was completely lead by one-party.

During the Q&A section of the talk came the million dollar question: Should I wait to implement an EMR until the stimulus package is announced and will there be money for me if I don’t have an EMR? This question is the core of the Obama campaign in my opinion. The question of what can government do for you? Right or wrong, what sensible business owner (a.k.a. practicing physician) would not take federal money to build or grow their practice?

The presenters responded by saying it is hard to see exactly what will happen with the stimulus package, but the package will contain very large funding amounts. Further, they indicated that government programs don’t typically award funds to existing systems preferring to help with more ground-up implementations. However, in the world of increasing competition for dollars, being able to show a successful implementation and making a case for rapid deployment and expansion may be an effective strategy. Bottom line, check-out systems that are certified and offer the best interoperability and data integration to plan for any future transitions to new systems. While you are doing your research, keep an eye on Washington for stimulus language to come out after the first of the year.

From where I sit, we live in some very interesting times in healthcare and today’s conventional wisdom could be tomorrow’s unemployment line. It’s time to start thinking differently in healthcare; start thinking about embracing technology.

Tags: Healthcare, Obama