Below are Peter Leibold's and other staffperson's reports from sessions at the Annual Meeting.
The Monday morning of the Annual has been enlightening so far. Bill Gates, Sr. and Senator Ron Wyden have spoken, with the latter emphasizing that the country will need bi-partisan support for needed further efforts on cost containment. He emphasized that the current law will increase transparency in costs and lead to more effective competition. Currently, Julie Barnes and Beth Schermer are discussing in detail the new law. Beth just announced that "Hanlester is dead" in her summary of changes to the Anti-Kickback law. She is now discussing the expansion of exclusion authorities and CMPs in the law. In addition, the False Claims Act has been narrowed so that the public disclosure bar applies only to federal proceedings and the original source exception has been broadened.
June 28, 10:45 PDT
Beth Schermer and Julie Barnes continue on their quest to reduce health reform to 90 minutes. Beth is describing the Medical Home grants to states to develop the concept of coordinating care more effectively. In 2011, there is a demo for Medical Homes for Medicaid as well. Julie is distinguishing the "medical home" from the PHOs of the 90s. Julie theorizes that it is different because the private sector has changed and matured.
Julie is discussing the new federal entities that will help align incentives and cut costs. There is a new Center of Innovation at CMS, an IPAB and MACPAC to provide expertise on cost containment efforts, and the Patient Centered Outcomes Research Institute, all of which have as a goal improving efficiency and quality while decreasing costs.
Julie is talking about how much costs will increase over the next five years even as we try to change the system so that the resources are spent more wisely and efficiently. She is discussing some of the efforts specifically to reduce expenditures. Starting in 2018 (if it happens), there will be a 40% excise tax on plan values that exceeds rouhgly $10,000 and $27,000.
June 28, 12:15 pm PDT
Jack Schroder and Beth Schermer are giving their inimitable Year in Review. Jack just gave a strong overview of credentialling and medical staff cases. Beth is now discussing payment issues, including the difficult issue of the SGR and some litigation related to CMS's calculation of the Medicare portion of the Disproportionate Share Adjustment. She has moved onto pharmaceutical and biotech issues, including draft guidance from the FDA advisory committee's conflict of interest waiver policy. She is now reviewing life science company settlements with the government, including Synthes Spine Execs, KV Pharmaceuticals and Guidant. Jack Schroder has begun reviewing managed care issues, including Anthem's request for a 39 percent premium increase in California and several cases won by payors. As always, this comprehensive review of developments in health law over the last year is a highlight.
June 28, 12:31 pm
I have to post just one more time. I have had two members in the last two minutes tell me how amazing Beth and Jack are for the amount of work they put into preparing this session. I really do want to commend both of them and Julie Barnes for an incredible amount of work and a terrific job on the Year in Reviews given this morning.
June 30, 9:00 am PDT
Back in sessions after several days of governance committee meetings. Gary Davis is now discussing the definition of Accountable Care Organizations. CMS is holding open door forums and getting feedback. Gary is saying that the current notion is that ACOs are fee for service entities where shared savings are distributed when quality benchmarks are met. Gary pointed out that the concept has serious fraud and abuse implications. Gary stresses that there is no one model. This session is entitled "ACOs are not PHOs Version 2.0" and Gary summarizes the differences. PHOs did not engage in best practices or evidenced based medicine. ACOs should. ACOs must contract with CMS for each three years, which envisions a longer life-shelf whereas PHOs tended to focus much of their governance documents on how to unwind them if things went wrong. Kim Looney is discussing the Medical Home. Its an effort to improve continuity of care by making the primary care physician responsible for coordinating the overall care and wellness of the patient. The Medical Home is not accountable for the cost of the care but is responsible for the overall coordination. Supposed to be guided by evidence based medicine. The hope, but not the goal, is to reduce costs and improve care. Quality and safety are the Medical Home's benchmarks. Medical Home driven by shortage of primary physicians and the proliferation of chronic care. One issue is making sure that physicians receive adequate compensation for the investments needed to make this concept work. Gary has a good grid that compares ACOs, Medical Homes and HIZs (which did not make it into the final legislation).
June 30, 11:30 am PDT
I am now in Peter Pavarini's and Kristen Rosati's session entitled "Health Information Exchange in the Post HITECH, Post-Reform Environment." Peter discussed ACOs and now Kristen is providing an overview of the HITECH Act, observing that additional resources made available by the federal government has really stimulated activity in the electronic health record area. Kristen is approaching her talk in a creative way - by discussing the challenges that OCR will have in balancing privacy with the goals of reducing cost and promoting efficiency in the Health Information Exchange. She thinks it is good that OCR is not going to enforce new privacy statutory requirements until there are final amendments to privacy regulations. Kristen is discussing the challenges in protecting privacy and utilizing the benefits of a Health Information Exchange fully. The HITECH Act requires that providers restrict uses, disclosures and requests for Personal Health Information to the "minimum necessary" amount to fulfill the request. The HITECH Act will not permit direct or indirect remuneration for disclosure of PHI without the patient's authorization. She is discussing the balance between the need for electronic health information for research and a price cap that restricts the amount of remuneration that can be paid for health information. This is an interesting session on the challenges to OCR and the challenge of balancing privacy protection with the laudable goals of increasing quality, increasing efficiency, and reducing cost.
June 30, 2:15 pm PDT
Attended an interesting Long Term Care Practice Group lunch that focused on effective employer responses to employee use of social technology. Now, I am in a sessions entitled HIT Hits the Fan: An Overview of the 2009 and 2010 HITECH Regulations. They are now discussing covered entities' obligations when a breach occurs, and the covered entity has been notified. HHS estimates that there will be 106 data breaches per year with 2.9 million affected individuals. The reality is that OCR has received notice of 6,000 breaches affecting less than 500 and 99 breaches of 500+ with a total of 3.46 million affected individuals. Trish is discussing a Tennessee Blue Cross case in which they had not wiped clean old computer hard drives, and the computers were stolen. Blue Cross has spent well over 7 million dollars trying to deal with the fallout. Jud is now discussing amendments to HIPAA. HIPAA security provisions now apply to Business Associates, as of 2/17/10. They have also added significant enforcement teeth.
June 30, 3:00 pm PDT
I am now in a session entitled "Tweet Tweet Goes Patient Information - Emerging Issues for Healthcare Employers in the Age of Twitter, MySpace and Facebook." I am extremely interested in the cutting edge issues of how employers can protect themselves from the negative excesses associated with these new social technologies. Mark Peters is now reviewing cases where there was a disclosure of protected health information published by employees on MySpace and Facebook. The issues raised by these disclosures and by the use of social technology include privacy claims resulting from HIPAA violations, employee productive and safety concerns (Mark takes serious issue with an Australian study that finds moderate use of Facebook increases productivity), employer monitoring (do we want to know?), ethical implications for lawyers if use subterfuge to look at Facebook pages, and employer use of social media for pre-employment screening, among others. Mark now is discussing how to craft workplace technology policies that work and make sense. In drafting them, one must set reasonable expectations about privacy. One must understand how careless disclosures might occur and address those circumstances. One must reinforce the special importance of confidentiality for healthcare providers. One should consider whether personal use of social media at work should be limited or prohibited. One must address management use of social media. These are fascinating and complicated issues.