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This Week in Health Care Reform EasyToInsureME FEBRUARY 5 2010   

Despite proclaiming to focus on other issues, such as the economy and jobs, President Barack Obama injected new energy into the health care reform debate this week.

On Monday, President Obama held a Q&A session via YouTube in which he responded to questions submitted during his State of the Union address. He commented that “it is my greatest hope” to have health care reform legislation “not just a year from now, but soon.” He also responded to criticisms regarding the lack of transparency around the reform negotiations.

On Tuesday, at a town-hall-style meeting in New Hampshire, President Obama rejected the notion that health care reform was dead, saying “we’ve got to punch it through.” Further, on Wednesday, he met with Senate Democrats reiterating his commitment to reform and encouraging lawmakers to press forward. He also suggested that Republicans play at least some role in negotiating a final bill.

Health Care Reform Negotiations

Democrats Look for Path Forward: Recent statements made by Rep. Charles Rangel (D-NY) are the first concrete signs that Democrats have started working to revive comprehensive health care reform legislation. Rep. Rangel indicated to the media that lawmakers have begun writing a compromise bill based on the legislation passed by the Senate last December. The bill will incorporate changes agreed upon last month by White House negotiators and members of the House and Senate.

Senate Majority Leader Harry Reid (D-NV) did not commit to a timeline for reform, but hopes that Democrats can agree to a path forward by next week. So far, he has been unable to identify compromise language that will win the needed 51 Senate votes.

At the same time, Speaker of the House Nancy Pelosi (D-CA) indicated that the House would vote on a small piece of the overall health care reform package next week. The proposed bill would overturn the insurance industry’s exemption from federal antitrust laws. The Senate version of health care reform did not include this measure because Sen. Reid could not secure the 60 votes needed to include it; however, Sen. Reid indicated the Senate would reconsider the measure.

Additional Activities

President Obama’s Budget Assumes Health Care Reform: On Monday, White House officials released a proposed $3.8 trillion 2011 budget including several measures aimed at improving health care:

·        Hiring more fraud detectives to root out waste in Medicare and Medicaid

·        Providing $25.5 billion to help state Medicaid programs swelling with enrollment due to unemployment

·        Eliminating Congressional earmarks for building hospitals and other facilities, including $10 million for Alaska and $35 million for Mississippi

·        Initiating or increasing funds for the following research projects:

o       quality improvements for seniors with chronic conditions

o       effective medical treatments for the costliest conditions

o       expeditious ways to adopt electronic medical records

o       medical fields such as genetic medicine that may provide breakthrough treatments.

Further, the budget assumes that some form of health care reform legislation will pass Congress. It includes a “reserve fund for health care reform” totaling $634 billion as a “down payment” for the legislation and also assumes that the reform effort will generate $150 billion in savings over 10 years.

States Begin Initiatives to Expand Coverage: With the fate of national health care reform in question, state legislators are pushing their own bills to expand coverage. Last Thursday, California’s State Senate passed a measure to create a government-run health care system, ignoring a veto threat from Gov. Arnold Schwarzenegger. The measure is now with the State Assembly. Missouri legislators have introduced a similar bill to create a government-run plan whereas lawmakers in other states, including Virginia and New Jersey, are working to tweak existing state programs to expand coverage. Tight budgets in all of those states may hinder these efforts.

Virginia Senate Says No to Individual Mandates: On Monday, Virginia’s Democratic-controlled State Senate passed measures that would make it illegal to enforce an individual health care mandate. This decision comes in direct conflict with the House and the Senate health care reform bills, both of which require all individuals to purchase health insurance.

Public Opinion

Majority of Americans Doubt Passage of Health Care Reform, but Growing Optimism: A survey released by the Pew Research Center on Wednesday shows growing optimism around the passage of health care reform. While the poll indicates that the majority of Americans (60 percent) do not believe health care reform legislation will pass this year, the figure is down from the 67 percent who said – just after a special Senate election was held last month in Massachusetts – that such legislation would not pass.

Poll Indicates Damage Done On Health Care Reform: A poll released Tuesday by Public Policy Polling shows that Republicans currently have the advantage over Democrats in the ballot races for Congress, regardless of the final outcome of health care reform. In general, the poll shows that 43 percent of voters surveyed would vote for a Republican, whereas 40 percent would vote for a Democrat. When asked about the implications of the health care overhaul.

* If health care reform passes, 45 percent would likely vote Republican and 40 percent would likely vote Democrat.
* If health care reform does not pass, 43 percent would likely vote Republican and 38 percent would likely vote Democrat.

The poll also shows that 36 percent of respondents support the President’s health care reform effort, while 51 percent oppose it.

Looking Ahead

Currently there is no timeline for the development of a comprehensive health care reform package. However, Speaker Pelosi is moving forward with smaller pieces of the bill, starting next week with the repeal of the antitrust exemption for insurance companies.

WHEN

In 2004, President Bush issued an executive order requiring fully operational EHR adoption throughout the healthcare industry by 2014. He also established the Office of the National Health Information Technology Coordinator and charged it with developing a “health information technology infrastructure” that “reduces healthcare costs resulting from inefficiency, medical errors, inappropriate care and incomplete information.” In November 2006, the Medicaid Commission completed its second and final set of recommendations to Congress, recommending that EHRs, including compatibility among different healthcare providers, be required for all Medicaid beneficiaries by 2012. Congress will focus on healthcare information technology during its 2007 legislative session.

Today, EHR adoption is slow among healthcare providers in general – one study shows that only eight percent of community health centers are using full electronic medical record systems. A September 2006 National Council quick poll of community behavioral health providers across the country indicates that just under eight percent have implemented the EHR with clinical components fully functioning, while 32 percent have implemented the EHR with billing components in place. Another 11 percent of providers are in the process of installing an EHR. Lack of funding and the complex demands of multiple payer and reporting systems are the biggest barriers to EHR adoption in behavioral and mental health patients.

WHY

EHR adoption is expected to reduce healthcare costs by up to 20 percent, significantly cutting back on the approximately 25 cents of every healthcare dollar that is now spent on record keeping and “administrivia” (according to James Kretz, MA, a senior survey statistician at SAMHSA’s Center for Mental Health Services).

The National Council quick poll revealed that 26 percent of behavioral healthcare and mental health organizations with functional EHRs realized improved quality assurance. Twenty two percent had been able to reduce billing errors and 17 percent realized improved clinical productivity with EHR implementation. Providers also point out that the EHR offers critical support to the service improvement process. The EHR promotes the application of protocols and guidelines, helps to maintain contact with individuals who move through a complex system and who are hospitalized in local or state hospitals, lose stable housing, or become entangled in the criminal justice system.

Most of all, the EHR holds the promise to reduce the enormous financial burden of paperwork and reporting duplication. We know the problems of a paper-based system and certainly the substantial and cumulative economic impact.

A study of one community mental health center in California found a host of inefficiencies that could be easily overcome with adoption of an EHR.

- 3,000 to 10,000 hours of care, with an annual value between $360,000 and $1,000,000, were going undocumented.

- 25,000 to 42,000 hours of clinician time, with an annual value of $2.2 to $3.7 million, were lost due to inefficiencies in the manual paperwork completion process.

- 13,000 to 20,000 hours of support staff time, with an annual value between $500,000 and $700,000, were spent on unnecessary medical records work.

HOW

Implementing the EHR is a difficult challenge in any healthcare organization. In behavioral healthcare and mental health, it’s particularly difficult because of the extraordinary regulatory burden placed on provider organizations by the combination of federal, state, and local funding sources. In Oregon, as counties were completing their specifications for the EHR, one county identified 188 different forms that they use on a regular basis.

Providers must recognize that the adoption of EHRs is much more than simply purchasing software. It represents a cultural and technological revolution. Members sharing their experiences in this issue of National Council News highlight that there are two keys to successful implementation – outstanding leadership and intensive project management. The organization’s leadership must drive the revolution, recognizing that it impacts every aspect of the organization’s structure and staff. The project manager must especially focus on bringing all facets of the organization together to collaborate on EHR implementation.

Providers going down the EHR path are rightly concerned about the lack of standards for software and hardware. The federal Behavioral Health Treatment Standards Group at the Substance Abuse and Mental Health Services Administration is working to address this very concern. BHTS comprises mental health and addiction treatment providers, the National Council, national trade associations, technology vendors, and federal organizations. This group was convened in 2004 to ensure that the national standards-setting process for the EHR reflects the needs of behavioral healthcare stakeholders.