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The legislative landscape for health care after House passage | KeithHennessey.com

briantedwards@gmail.com (Brian T. Edwards) — Mon, 09 Nov 2009 20:15:46 PST

The legislative landscape for health care after House passage

Posted By kbh On November 9, 2009 @ 12:45 pm In budget, featured, health | 8 Comments

The House passed their version of health care reform Saturday night on a 220-215 vote. Today I’m going to update my projections and analysis, and focus on upcoming “pivot points” in the health care debate.

Pass a partisan comprehensive bill through the House and through the regular Senate process with 60, leading to a law this year; (was 50% –> 40%)

Pass a partisan comprehensive bill through the House and through the reconciliation process with 51 Senate Democrats, leading to a law this year; (was 10% –> 20%)

Fall back to a much more limited bill that becomes law this year; (was 10% –> 20%)

No bill becomes law this year Congress. Process continues into next year. (was 29.99% –> 20%)

I have adjusted the scenarios based on two assumptions, making the new numbers not precisely comparable with the old:

I assume the Finance Committee bipartisan solution path is dead (I only had it at 0.01% chance last time); and

I assume virtually no chance of a signed law this year, so I have adapted the timeframes accordingly. I say this despite recent statements from the President and Leader Reid that they want/intend to get a law by 31 December.

Pivot points and the importance of recess

Pivot points (my term) are opportunities for legislative momentum to shift. These opportunities are to some extent predictable. This past week had four pivot points, which is extraordinary:

Election Day – loss of momentum for D’s;

the Senate Democratic Policy Lunch on Tuesday – loss of momentum for D’s;

Friday’s politically challenging employment report – loss of momentum for D’s; and

Saturday night’s House passage vote – momentum gain for D’s.

Sometimes a pivot point will pass without any noticeable change in the legislative outlook. But to the extent these dates/events are predictable, it at least tells you when to look for important shifts.

Here are obvious pivot points over the next few months:

every Tuesday after the Senate Democratic Policy Lunch;

whenever CBO releases its score of the Reid substitute amendment;

the Monday/Tuesday after Thanksgiving recess;

Friday, December 4th, when the next jobs report is released;

Th/F December 17-18, the end of the week before the Christmas recess;

the first week Members are back in DC after the holiday recess;

late January, for the President’s State of the Union Address.

The most potentially significant consequence of the slower schedule is that Members will be home for two long recesses before a bill might be completed. Will Members feel the same intensity of pressure they did in August? If so, that could greatly shift momentum.

Will Leader Reid will begin Senate floor consideration before Thanksgiving recess? If he does, then he will probably have to show his amendment to the world before that recess, and expose his Members to pressure on specific text over that short break. If he waits until after recess, his Members may have a slightly less painful Thanksgiving break, but at the expense of lost time on the backend and a lower probability of Senate passage before Christmas. I would expect him to try to “back up” final passage before the Christmas recess, by in effect telling the Senate around December 18th “you can go home for Christmas only after we’ve finished the bill.” The smell of jet fumes is usually enough to cause Members to vote aye on cloture to shut off a filibuster, but in this case I’m not so sure.

The three-part strategic question

In December Democratic leaders may face a two-part strategic question:

If we cannot hold 60 D’s, do we use reconciliation to pass a bill with 51, or instead go for 60 on a much more limited bill?

When do we make this decision?

Conference or ping pong?

My survey of (Republican) insiders is split on what Democrats may decide on (1), but nearly unanimous on question (2): almost all say this strategic shift would come in January at the earliest. The earliest projection was December 18th.

I assume liberals would prefer a reconciliation path that would probably produce a bill closer to the House-passed bill, at the price of painfully splitting off moderate Senate Democrats. This is a slash-and-burn partisan path, but may be the highest probability path to a signed law. I also assume moderate Democrats would prefer a scaled-back bill. We know Democratic moderates would support the Finance Committee reported bill, so if Senate liberals could swallow hard and wait for the next step, this would be the easiest path to Senate passage. Leader Reid tacked away from this when he announced his amendment would contain a strong public option.

If the Senate can pass a bill, Democratic leaders will need to wrestle with question (3).

Conference or ping pong?

Everyone knew the House would eventually pass something, given the enormous Democratic margin in the House. House Republicans were more effective in their resistance than I anticipated. This contributes to an apparent loss of momentum in the Senate. There are now two games ahead: Senate passage, and reconciling differences between the House and Senate.

In theory, if the Senate passes a bill, the chance of a law skyrockets. But the House passed its bill with a left-edge coalition – most of the Democratic no votes were from moderates. If the Senate passes a bill through regular order (with 60 votes), it will be relatively more moderate, and more compatible with an alliance on the other side of Pelosi’s caucus. This could be quiet difficult. How do Speaker Pelosi and Leader Reid work out differences between a bill that Lieberman, Nelson, and Lincoln support and one opposed by moderate House D’s? Splitting the difference may alienate both sides of the Democratic caucuses. We’re already starting to see lines drawn in the sand on abortion.

This is why some observers think Senate passage may lead to ping pong rather than a conference. Normally after the House and Senate pass versions of a bill, the body that votes second requests a conference with the other body and appoints a handful of members to be conferees. The second body then agrees to a conference and appoints its own conferees. The conferees negotiate and produce pretty much whatever new text they want, although they generally stay within the scope of the contents of the two bills. The conference report language must then be passed by both bodies to go to the President.

Ping pong is a colloquial term for skipping conference. The House-passed bill will soon arrive in the Senate. The Senate will presumably take up the House bill and amend it. If and when the Senate passes its version, it would not request a conference, and would not appoint conferees, but would instead send the amended bill back to the House. the House could then try to further amend the Senate bill, or just take it up and pass it. This ping pong can go back and forth a few times.

Conventional wisdom seems to be that House and Senate Democratic leaders are intensely focused on the downsides of a conference. It puts tremendous pressure on the leaders and conferees to resolve differences. It also gives House and Senate Republicans certain procedural opportunities to cause mischief before and during conference.

But ping pong has its own downsides. The minority, especially in the Senate, gets another crack at amending the bill. Smart money would bet today on ping pong rather than a conference, but I expect this to be revisited often over the next couple of months.

My projections

It is highly likely the legislative process will continue at least into January.

I am still projecting a 60% chance that a comprehensive bill becomes law this year, but I have shifted some of that 60% from the regular order path to the reconciliation path. By itself I’d never expect the Senate to shift to a reconciliation path after failing to get 60 – Senate-only logic says heck no, and the strain on Reid’s caucus would be too great. But if Democratic leaders are forced to shift away from regular order on a comprehensive bill, I would guess that Speaker Pelosi would push hard for the Senate to use reconciliation to produce a bill more compatible with the House-passed bill rather than dialing back expectations. This puts me at 40% regular order success, 20% reconciliation success, 20% fall back to a narrower bill, and a 20% chance the whole thing implodes. It’s the slow pace and the two intervening recesses that give me hope.

Insiders: Please send me your thoughts privately, especially if you disagree.

(photo credit: Speaker Pelosi’s site ^[1])

Article printed from KeithHennessey.com: http://keithhennessey.com

URL to article: http://keithhennessey.com/2009/11/09/after-house-passage/

URLs in this post:

[1] Speaker Pelosi’s site: http://www.speaker.gov/newsroom/photogallery?id=0009

Click here to print.

via keithhennessey.com

Analyzing the impact of the House vote to pass health reform this past weekend.

Posted via web from Connected Care Solutions

KeithHennessey.com » The legislative landscape for health care after House passage » Print

briantedwards@gmail.com (Brian T. Edwards) — Mon, 09 Nov 2009 20:10:25 PST

The legislative landscape for health care after House passage

Posted By kbh On November 9, 2009 @ 12:45 pm In budget, featured, health | 8 Comments

The House passed their version of health care reform Saturday night on a 220-215 vote. Today I’m going to update my projections and analysis, and focus on upcoming “pivot points” in the health care debate.

Pass a partisan comprehensive bill through the House and through the regular Senate process with 60, leading to a law this year; (was 50% –> 40%)

Pass a partisan comprehensive bill through the House and through the reconciliation process with 51 Senate Democrats, leading to a law this year; (was 10% –> 20%)

Fall back to a much more limited bill that becomes law this year; (was 10% –> 20%)

No bill becomes law this year Congress. Process continues into next year. (was 29.99% –> 20%)

I have adjusted the scenarios based on two assumptions, making the new numbers not precisely comparable with the old:

I assume the Finance Committee bipartisan solution path is dead (I only had it at 0.01% chance last time); and

I assume virtually no chance of a signed law this year, so I have adapted the timeframes accordingly. I say this despite recent statements from the President and Leader Reid that they want/intend to get a law by 31 December.

Pivot points and the importance of recess

Pivot points (my term) are opportunities for legislative momentum to shift. These opportunities are to some extent predictable. This past week had four pivot points, which is extraordinary:

Election Day – loss of momentum for D’s;

the Senate Democratic Policy Lunch on Tuesday – loss of momentum for D’s;

Friday’s politically challenging employment report – loss of momentum for D’s; and

Saturday night’s House passage vote – momentum gain for D’s.

Sometimes a pivot point will pass without any noticeable change in the legislative outlook. But to the extent these dates/events are predictable, it at least tells you when to look for important shifts.

Here are obvious pivot points over the next few months:

every Tuesday after the Senate Democratic Policy Lunch;

whenever CBO releases its score of the Reid substitute amendment;

the Monday/Tuesday after Thanksgiving recess;

Friday, December 4th, when the next jobs report is released;

Th/F December 17-18, the end of the week before the Christmas recess;

the first week Members are back in DC after the holiday recess;

late January, for the President’s State of the Union Address.

The most potentially significant consequence of the slower schedule is that Members will be home for two long recesses before a bill might be completed. Will Members feel the same intensity of pressure they did in August? If so, that could greatly shift momentum.

Will Leader Reid will begin Senate floor consideration before Thanksgiving recess? If he does, then he will probably have to show his amendment to the world before that recess, and expose his Members to pressure on specific text over that short break. If he waits until after recess, his Members may have a slightly less painful Thanksgiving break, but at the expense of lost time on the backend and a lower probability of Senate passage before Christmas. I would expect him to try to “back up” final passage before the Christmas recess, by in effect telling the Senate around December 18th “you can go home for Christmas only after we’ve finished the bill.” The smell of jet fumes is usually enough to cause Members to vote aye on cloture to shut off a filibuster, but in this case I’m not so sure.

The three-part strategic question

In December Democratic leaders may face a two-part strategic question:

If we cannot hold 60 D’s, do we use reconciliation to pass a bill with 51, or instead go for 60 on a much more limited bill?

When do we make this decision?

Conference or ping pong?

My survey of (Republican) insiders is split on what Democrats may decide on (1), but nearly unanimous on question (2): almost all say this strategic shift would come in January at the earliest. The earliest projection was December 18th.

I assume liberals would prefer a reconciliation path that would probably produce a bill closer to the House-passed bill, at the price of painfully splitting off moderate Senate Democrats. This is a slash-and-burn partisan path, but may be the highest probability path to a signed law. I also assume moderate Democrats would prefer a scaled-back bill. We know Democratic moderates would support the Finance Committee reported bill, so if Senate liberals could swallow hard and wait for the next step, this would be the easiest path to Senate passage. Leader Reid tacked away from this when he announced his amendment would contain a strong public option.

If the Senate can pass a bill, Democratic leaders will need to wrestle with question (3).

Conference or ping pong?

Everyone knew the House would eventually pass something, given the enormous Democratic margin in the House. House Republicans were more effective in their resistance than I anticipated. This contributes to an apparent loss of momentum in the Senate. There are now two games ahead: Senate passage, and reconciling differences between the House and Senate.

In theory, if the Senate passes a bill, the chance of a law skyrockets. But the House passed its bill with a left-edge coalition – most of the Democratic no votes were from moderates. If the Senate passes a bill through regular order (with 60 votes), it will be relatively more moderate, and more compatible with an alliance on the other side of Pelosi’s caucus. This could be quiet difficult. How do Speaker Pelosi and Leader Reid work out differences between a bill that Lieberman, Nelson, and Lincoln support and one opposed by moderate House D’s? Splitting the difference may alienate both sides of the Democratic caucuses. We’re already starting to see lines drawn in the sand on abortion.

This is why some observers think Senate passage may lead to ping pong rather than a conference. Normally after the House and Senate pass versions of a bill, the body that votes second requests a conference with the other body and appoints a handful of members to be conferees. The second body then agrees to a conference and appoints its own conferees. The conferees negotiate and produce pretty much whatever new text they want, although they generally stay within the scope of the contents of the two bills. The conference report language must then be passed by both bodies to go to the President.

Ping pong is a colloquial term for skipping conference. The House-passed bill will soon arrive in the Senate. The Senate will presumably take up the House bill and amend it. If and when the Senate passes its version, it would not request a conference, and would not appoint conferees, but would instead send the amended bill back to the House. the House could then try to further amend the Senate bill, or just take it up and pass it. This ping pong can go back and forth a few times.

Conventional wisdom seems to be that House and Senate Democratic leaders are intensely focused on the downsides of a conference. It puts tremendous pressure on the leaders and conferees to resolve differences. It also gives House and Senate Republicans certain procedural opportunities to cause mischief before and during conference.

But ping pong has its own downsides. The minority, especially in the Senate, gets another crack at amending the bill. Smart money would bet today on ping pong rather than a conference, but I expect this to be revisited often over the next couple of months.

My projections

It is highly likely the legislative process will continue at least into January.

I am still projecting a 60% chance that a comprehensive bill becomes law this year, but I have shifted some of that 60% from the regular order path to the reconciliation path. By itself I’d never expect the Senate to shift to a reconciliation path after failing to get 60 – Senate-only logic says heck no, and the strain on Reid’s caucus would be too great. But if Democratic leaders are forced to shift away from regular order on a comprehensive bill, I would guess that Speaker Pelosi would push hard for the Senate to use reconciliation to produce a bill more compatible with the House-passed bill rather than dialing back expectations. This puts me at 40% regular order success, 20% reconciliation success, 20% fall back to a narrower bill, and a 20% chance the whole thing implodes. It’s the slow pace and the two intervening recesses that give me hope.

Insiders: Please send me your thoughts privately, especially if you disagree.

(photo credit: Speaker Pelosi’s site ^[1])

Article printed from KeithHennessey.com: http://keithhennessey.com

URL to article: http://keithhennessey.com/2009/11/09/after-house-passage/

URLs in this post:
[1] Speaker Pelosi’s site: http://www.speaker.gov/newsroom/photogallery?id=0009

Click here to print.

via keithhennessey.com

Analyzing the impact of the House vote to pass health reform this past weekend.

Posted via web from Connected Care Solutions

KeithHennessey.com » The legislative landscape for health care after House passage » Print

briantedwards@gmail.com (Brian T. Edwards) — Mon, 09 Nov 2009 20:09:47 PST

The legislative landscape for health care after House passage

Posted By kbh On November 9, 2009 @ 12:45 pm In budget, featured, health | 8 Comments

The House passed their version of health care reform Saturday night on a 220-215 vote. Today I’m going to update my projections and analysis, and focus on upcoming “pivot points” in the health care debate.

Pass a partisan comprehensive bill through the House and through the regular Senate process with 60, leading to a law this year; (was 50% –> 40%)

Pass a partisan comprehensive bill through the House and through the reconciliation process with 51 Senate Democrats, leading to a law this year; (was 10% –> 20%)

Fall back to a much more limited bill that becomes law this year; (was 10% –> 20%)

No bill becomes law this year Congress. Process continues into next year. (was 29.99% –> 20%)

I have adjusted the scenarios based on two assumptions, making the new numbers not precisely comparable with the old:

I assume the Finance Committee bipartisan solution path is dead (I only had it at 0.01% chance last time); and

I assume virtually no chance of a signed law this year, so I have adapted the timeframes accordingly. I say this despite recent statements from the President and Leader Reid that they want/intend to get a law by 31 December.

Pivot points and the importance of recess

Pivot points (my term) are opportunities for legislative momentum to shift. These opportunities are to some extent predictable. This past week had four pivot points, which is extraordinary:

Election Day – loss of momentum for D’s;

the Senate Democratic Policy Lunch on Tuesday – loss of momentum for D’s;

Friday’s politically challenging employment report – loss of momentum for D’s; and

Saturday night’s House passage vote – momentum gain for D’s.

Sometimes a pivot point will pass without any noticeable change in the legislative outlook. But to the extent these dates/events are predictable, it at least tells you when to look for important shifts.

Here are obvious pivot points over the next few months:

every Tuesday after the Senate Democratic Policy Lunch;

whenever CBO releases its score of the Reid substitute amendment;

the Monday/Tuesday after Thanksgiving recess;

Friday, December 4th, when the next jobs report is released;

Th/F December 17-18, the end of the week before the Christmas recess;

the first week Members are back in DC after the holiday recess;

late January, for the President’s State of the Union Address.

The most potentially significant consequence of the slower schedule is that Members will be home for two long recesses before a bill might be completed. Will Members feel the same intensity of pressure they did in August? If so, that could greatly shift momentum.

Will Leader Reid will begin Senate floor consideration before Thanksgiving recess? If he does, then he will probably have to show his amendment to the world before that recess, and expose his Members to pressure on specific text over that short break. If he waits until after recess, his Members may have a slightly less painful Thanksgiving break, but at the expense of lost time on the backend and a lower probability of Senate passage before Christmas. I would expect him to try to “back up” final passage before the Christmas recess, by in effect telling the Senate around December 18th “you can go home for Christmas only after we’ve finished the bill.” The smell of jet fumes is usually enough to cause Members to vote aye on cloture to shut off a filibuster, but in this case I’m not so sure.

The three-part strategic question

In December Democratic leaders may face a two-part strategic question:

If we cannot hold 60 D’s, do we use reconciliation to pass a bill with 51, or instead go for 60 on a much more limited bill?

When do we make this decision?

Conference or ping pong?

My survey of (Republican) insiders is split on what Democrats may decide on (1), but nearly unanimous on question (2): almost all say this strategic shift would come in January at the earliest. The earliest projection was December 18th.

I assume liberals would prefer a reconciliation path that would probably produce a bill closer to the House-passed bill, at the price of painfully splitting off moderate Senate Democrats. This is a slash-and-burn partisan path, but may be the highest probability path to a signed law. I also assume moderate Democrats would prefer a scaled-back bill. We know Democratic moderates would support the Finance Committee reported bill, so if Senate liberals could swallow hard and wait for the next step, this would be the easiest path to Senate passage. Leader Reid tacked away from this when he announced his amendment would contain a strong public option.

If the Senate can pass a bill, Democratic leaders will need to wrestle with question (3).

Conference or ping pong?

Everyone knew the House would eventually pass something, given the enormous Democratic margin in the House. House Republicans were more effective in their resistance than I anticipated. This contributes to an apparent loss of momentum in the Senate. There are now two games ahead: Senate passage, and reconciling differences between the House and Senate.

In theory, if the Senate passes a bill, the chance of a law skyrockets. But the House passed its bill with a left-edge coalition – most of the Democratic no votes were from moderates. If the Senate passes a bill through regular order (with 60 votes), it will be relatively more moderate, and more compatible with an alliance on the other side of Pelosi’s caucus. This could be quiet difficult. How do Speaker Pelosi and Leader Reid work out differences between a bill that Lieberman, Nelson, and Lincoln support and one opposed by moderate House D’s? Splitting the difference may alienate both sides of the Democratic caucuses. We’re already starting to see lines drawn in the sand on abortion.

This is why some observers think Senate passage may lead to ping pong rather than a conference. Normally after the House and Senate pass versions of a bill, the body that votes second requests a conference with the other body and appoints a handful of members to be conferees. The second body then agrees to a conference and appoints its own conferees. The conferees negotiate and produce pretty much whatever new text they want, although they generally stay within the scope of the contents of the two bills. The conference report language must then be passed by both bodies to go to the President.

Ping pong is a colloquial term for skipping conference. The House-passed bill will soon arrive in the Senate. The Senate will presumably take up the House bill and amend it. If and when the Senate passes its version, it would not request a conference, and would not appoint conferees, but would instead send the amended bill back to the House. the House could then try to further amend the Senate bill, or just take it up and pass it. This ping pong can go back and forth a few times.

Conventional wisdom seems to be that House and Senate Democratic leaders are intensely focused on the downsides of a conference. It puts tremendous pressure on the leaders and conferees to resolve differences. It also gives House and Senate Republicans certain procedural opportunities to cause mischief before and during conference.

But ping pong has its own downsides. The minority, especially in the Senate, gets another crack at amending the bill. Smart money would bet today on ping pong rather than a conference, but I expect this to be revisited often over the next couple of months.

My projections

It is highly likely the legislative process will continue at least into January.

I am still projecting a 60% chance that a comprehensive bill becomes law this year, but I have shifted some of that 60% from the regular order path to the reconciliation path. By itself I’d never expect the Senate to shift to a reconciliation path after failing to get 60 – Senate-only logic says heck no, and the strain on Reid’s caucus would be too great. But if Democratic leaders are forced to shift away from regular order on a comprehensive bill, I would guess that Speaker Pelosi would push hard for the Senate to use reconciliation to produce a bill more compatible with the House-passed bill rather than dialing back expectations. This puts me at 40% regular order success, 20% reconciliation success, 20% fall back to a narrower bill, and a 20% chance the whole thing implodes. It’s the slow pace and the two intervening recesses that give me hope.

Insiders: Please send me your thoughts privately, especially if you disagree.

(photo credit: Speaker Pelosi’s site ^[1])

Article printed from KeithHennessey.com: http://keithhennessey.com

URL to article: http://keithhennessey.com/2009/11/09/after-house-passage/

URLs in this post:
[1] Speaker Pelosi’s site: http://www.speaker.gov/newsroom/photogallery?id=0009

Click here to print.

via keithhennessey.com

Analyzing the impact of the House vote to pass health reform this past weekend.

Posted via web from Connected Care Solutions

GE Healthymagination Fund - Investment Platform

briantedwards@gmail.com (Brian T. Edwards) — Mon, 09 Nov 2009 19:45:33 PST

Investment Platform

The Healthymagination Fund draws on capabilities from across GE Healthcare, GE Capital and GE Global Research and has a global footprint. The investment committee is comprised of senior leaders of these groups.

via healthymaginationfund.com

Exciting new $250mm HIT investment fund launched by GE Capital offers unprecedentedly aggressive and bullish HIT private equity joint venture. Ideas abound...

Posted via web from Connected Care Solutions

Telemedicine: CMS definition and reimbursement guidelines

briantedwards@gmail.com (Brian T. Edwards) — Thu, 29 Oct 2009 11:17:35 PDT

Telemedicine and Telehealth

Telemedicine

For purposes of Medicaid, telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient's health. Electronic communication means the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment permitting two-way, real time interactive communication between the patient, and the physician or practitioner at the distant site. Telemedicine is viewed as a cost-effective alternative to the more traditional face-to-face way of providing medical care (e.g., face-to-face consultations or examinations between provider and patient) that states may choose to cover. This definition is modeled on Medicare's definition of telehealth services located at 42 CFR 410.78. Note that the Federal Medicaid statute (Title XIX of the Social Security Act) does not recognize telemedicine as a distinct service.

Distant or Hub Site means the site at which the physician or other licensed practitioner delivering the service is located at the time the service is provided via telecommunications system.

Originating or Spoke site means the location of the Medicaid patient at the time the service being furnished via a telecommunications system occurs. Telepresenters may be needed to facilitate the delivery of this service.

Asynchronous or "Store and Forward" means transferring data from one site to another through the use of a camera or similar device that records (stores) an image that is sent (forwarded) via telecommunication to another site for consultation. Asynchronous or "store and forward" applications would not meet the above definition of telemedicine--see telehealth.

Reimbursement/Billing—Reimbursement for Medicaid covered services, including those with telemedicine applications, must satisfy federal requirements of efficiency, economy and quality of care. With this in mind, States are encouraged to use the flexibility inherent in federal law to create innovative payment methodologies for services that incorporate telemedicine technology. For example, States may reimburse the physician or other licensed practitioner at the distant site and reimburse a facility fee to the originating site. States can also reimburse any additional costs such as technical support, transmission charges, and equipment. These add-on costs can be incorporated into the fee-for-service rates or separately reimbursed as an administrative cost by the state. If they are separately billed and reimbursed, the costs must be linked to a covered Medicaid service. While telemedicine is not considered a distinct Medicaid service, any State wishing to cover/reimburse for telemedicine services should submit a State Plan Amendment to the Centers for Medicare and Medicaid Services for approval.

Medical Codes—States may select from a variety of HCPCS codes (T1014 and Q3014), CPT codes and modifiers (GT, U1-UD) in order to identify, track and reimburse for telemedicine services.

Telehealth (or Telemonitoring) is the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision and information across distance.

Telehealth includes such technologies as telephones, facsimile machines, electronic mail systems, and remote patient monitoring devices which are used to collect and transmit patient data for monitoring and interpretation. While they do not meet the Medicaid definition of telemedicine they are often considered under the broad umbrella of telehealth services. Even though such technologies are not considered "telemedicine," they may nevertheless be covered and reimbursed as part of a Medicaid coverable service under section 1905(a) of the Social Security Act such as laboratory service, x-ray service or physician services.

Other Considerations:

Medicaid guidelines require all providers to practice within the scope of their state practice act. Some States have enacted legislation which requires providers using telemedicine technology across state lines to have a valid state license in the state where the patient is located. Any such requirements or restrictions placed by the State are binding under current Medicaid rules. Medicare Conditions of Participation (COPs) applicable to settings such as long-term care facilities, and hospitals may also impact reimbursement for services provided via telemedicine technology. For instance, the Medicare COPs for long-term care facilities require physician visits at set intervals. Current regulations require that the physician must be physically present in the same room as the patient during the visit. This requirement must also be met for Medicaid to pay for services provided to Medicaid eligible patients while in a Medicare or Medicaid certified facility. Similarly, federal regulations require face-to-face visits for home health, and telemedicine cannot be used as a substitute for those visits. However, a telemedicine encounter may be used as a supplement to the required face-to-face visits

via cms.hhs.gov

Anyone eager to make a business out of remote care and telemedicine technologies must carefully read, re-read, and ultimately memorize the one-page guidelines above if they hope to remain a sustainable investment in the current environment. In my estimation, the most valuable by-product of a Billion-dollar US Connected Health sector will be its utility as a stimulant of hyper-innovation. Without a business plan and patient care protocols/procedures that achieve 75-100% reimbursement rates from CMS, any telemedicine program is doomed to be a money-pit regardless of the altruistic motives of its proponents. The entrepreneur who will emerge best-of-breed in telemedicine will be he/she who finds the shortest path to demonstrating "Meaningful Use" in the form of real improvement in patient outcomes.

Posted via web from Connected Care Solutions

National Coalition for Health Integration (NCHI): Bringing order to the chaotic health information technology through grid computing

briantedwards@gmail.com (Brian T. Edwards) — Thu, 29 Oct 2009 06:29:14 PDT

via scribd.com

The National Coalition for Health Integration (NCHI) initiative is an ambitious attempt to establish a truly interoperable environment for linking independent health information technology projects around the US through an open framework. With an all-star team of business and scientific directors funded entirely through private donations made by its principal founder, billionaire pharmaceutical entrepreneur Patrick Soon-Shiong, M.D., NCHI seeks to establish "virtual organizations" which combine numerous disparate health organizations across all sub-specialties and functional purposes (i.e. billing, administration, health records, etc.) and without concern for traditional geographic constraints. It utilizes in an unprecedented fashion institutes of higher education and their leading academic innovators in bio-informatics and grid computing. Truly a revolutionary initiative which will undoubtedly emerge as a major foundational element of any long-term improvement in the delivery of quality care. (www.nchiconnect.org)

Posted via web from Connected Care Solutions

BreakThrough: Teletherapy startup gaining some mainstream popularity, but business model is very misleading

briantedwards@gmail.com (Brian T. Edwards) — Thu, 29 Oct 2009 06:24:42 PDT

Overview

BreakThrough connects mental health professionals with clients through secure video, phone, and web.
We have a mental health epidemic

More than 57 million Americans – one in four adults – have a diagnosed mental illness. Tens of millions more struggle with stress and relationship issues. Institutions such as hospitals, prisons, schools, companies, health plans, and veterans centers are overcrowded with patients needing help, but growing costs and shrinking budgets are decimating quality of care.
Even though seventy to eighty percent of patients with mental illness improve with treatment, patients remain woefully underserved. Two–thirds of Americans with a mental illness do not receive treatment due to cost, stigma, inconvenience, and low access, particularly in rural areas. This is despite Americans spending $121 billion on mental health and substance abuse treatment.
The solution of telemedicine

Telepsychiatry and teletherapy – mental health services delivered through secure video, phone, and web – have emerged as effective, affordable, convenient, and safe methods of treating stress and mental illness. Telemedicine has several substantial benefits:
Effectiveness:

over fifteen years of research confirm that telemedicine is as effective as in–person treatment. This is particularly true in psychiatry and clinical psychology where much of the treatment is doctor–patient communication. Click here for a list of research studies on the effectiveness of telemedicine.
Convenience:

fifty percent of therapy clients drop out after a few sessions, but research shows teletherapy can boost retention to over ninety percent. Because clients can hold sessions anywhere with phone or internet access, they are much more likely to go and stay in treatment. BreakThrough supports sessions via video, phone, email, and live chat.
Affordability:

telemedicine sessions can cost ten to fifty percent less due to reduced overhead, travel time, and staffing needs. On BreakThrough, providers set rates that are almost always more affordable than in–office visits.
Access:

research shows the fit between clients and mental health providers is essential to positive outcomes. Most people will not travel to a provider beyond fifty miles, but telemedicine lets clients work with the best licensed provider regardless of location. BreakThrough clients can find providers on a wide variety of criteria, including price, reputation, location, gender, experience, credentials, and more.
Confidentiality:

eighty percent of therapy clients worry about the stigma of treatment. To protect clients, BreakThrough requires minimal information, enabling treatment with a level of discreteness and security not possible with in–person treatment.
Peer support:

the support of friends, family, and other patients is essential to long–term recovery. BreakThrough offers forums, group sessions, and seminars to enable peers to support each other no matter where they live.
Telemedicine is legal and expanding

Telepsychiatry and teletherapy are legal and regulated by state–specific guidelines. Government and licensing boards are also rapidly evolving legislation to expand telemedicine access.
To protect providers and meet the highest levels of regulatory compliance, we currently allow providers to see clients only in states where the provider is licensed. Providers can typically apply for licensure in multiple states, either directly through state licensing boards or third–party services that streamline the application process.
Telemedicine is reimburseable

Since 2004, Medicare and the AMA have issued CPT codes to identify and reimburse telepsychiatry and teletherapy services. A list of eligible services and codes include:

Individual psychotherapy: CPT 90804 – 90809
Consultations: CPT 99241 – 99255
Office or other outpatient visits: CPT 99201 – 99215
Pharmacologic management: CPT 90862
Psychiatric diagnostic interview examination:CPT 90801
Neurobehavioral status examination: CPT 96116

CPT code descriptions can be found on the American Medical Association's CPT directory. The modifier GT may be necessary to identify that services were delivered via telemedicine. For Medicare reimbursement, clients generally must receive treatment at an eligible originating site, such as a doctor's office, hospital, nursing facility, mental health clinic, or similar facility. Private payers often do not have the same locality restrictions. More details on reimbursement are available through the American Telemedicine Association.

via breakthrough.com

The premise underlying the business model for BreakThrough may well be sound, particularly the evidence presented supporting the positive impact of teletherapy on psychiatric patient outcomes. However, the increase in quality of treatment via telemedicine is irrelevant without a method for sustaining the provision of treatment through reimbursement of attending psychiatrists.

The assertion that "Telemedicine is reimbursable" made in the final section above, while accurate technically, is misleading in that eligibility to be reimbursed and actually recouping fees for services provided are two entirely different issues. The CPT codes provided by the BreakThrough founders are a distraction from the real challenge of processing and collecting payment, which is overcoming the fact that CPT codes are very often (more often than not) ignored because of the GT modifier and the advanced standards of practice that must be met to be eligible under Medicare reimbursement policy.

Medicare mandates clearly that telemedicine services are only eligible for reimbursement when there is a two-way video transmission that allows doctor and patient to each see the other. Any health professional will tell you that private insurers will always follow Medicare's guidance when it comes to establishing standards of eligibility for reimbursement.

This is going to create a major obstacle for the well intentioned and otherwise exciting startup to achieve widespread adoption amongst mental health providers, as they are not likely to adopt therapeutic practices without demonstrable evidence that reimbursement above a significant percentage of total consults is achievable. I wish the BreakThrough team the best of luck!!

Posted via web from Connected Care Solutions

AHRQ Report: Consumers Need to be Empowered in Health IT Debate

briantedwards@gmail.com (Brian T. Edwards) — Thu, 29 Oct 2009 06:23:52 PDT

via scribd.com

A new study out the Agency for Healthcare Research and Quality (AHRQ) suggests that by excluding consumers from the broader implementation of health information technologies, the medical community is marginalizing themselves and prolonging the time it will take to reach high levels of consumer adoption. Just another reason to add to the list of flawed approaches/perspectives on information technology among health professionals, though quite possibly the one issue that if addressed effectively could make all of the other impediments to ubiquitous adoption of highly advanced IT systems evaporate in the face of overwhelming consumer demand.

Posted via web from Connected Care Solutions

Telemedicine allows for long-distance diagnoses

briantedwards@gmail.com (Brian T. Edwards) — Thu, 29 Oct 2009 06:23:16 PDT

Link: Telemedicine allows for long-distance diagnoses - The Washington Times.

As mentioned in an earlier post, 4 years ago Telemedicine was in its infancy, perhaps used for monitoring status of patients with pacemakers... Now, according to this article in the Washington Times, Dr. Kenneth Bird, a Harvard professor affiliated with Massachusetts General Hospital, innovated an approach to patient care using monitors and remote access to hospitals to examine, diagnose and treat his patients.

Also, according to the article, patients are wearing monitors that can be remotely tracked and physicians can be notified and/or paged when necessary. Telemedicine (a.k.a. Telehealth) is not a substitute for direct patient care, but rather, it is an augmentation to the existing delivery of care. That said, installation/implementation can be a huge expense (ranging between $2.5 and $3.5 million), so larger hospitals are more likely to implement remote monitoring.

The article continues with explanation of "concierge" medicine approaches, which are light years ahead of the status quo. The benefits to patients is purportedly rapid care from providers, from home or within a specialized, technology enabled facility.

It's an interesting thought, and another example of how technologies can be used to improve patient care if used appropriately. That said, there are likely significant privacy and security issues related to the "transaction" between patient and providers. For more information about HIPAA Requirements, The HIPAA Privacy Rule, The Security Rule, or The HITECH Act visit The Online HIPAA Survival Guide.

And, if you are interested in keeping current on the issues, sign up for the FREE HITECH/HIPAA Compliance Newsletter.

via feedproxy.google.com

Courtesy of Healthcare & Technology Blog (By: Deborah Leyva): http://www.myhealthtechblog.com/2009/10/telemedicine-allows-for-long-distance-diagnoses.html

Telemedicine (Telehealth) is starting to get the attention it deserves, but innovation will not occur in a vacuum of unsustainable business models. Until self-sustainability for for telemedicine initiatives is achieved and replicated on a widespread basis it will not be as significant in the provision of care as it should be.

Posted via web from Connected Care Solutions

Larry Summers: "The average supermarket has more information technology than the average doctor's office"

briantedwards@gmail.com (Brian T. Edwards) — Thu, 29 Oct 2009 11:27:04 PDT

Larry Summers made this point on Meet the Press this morning while defending the American Recovery and Reinvestment Act (ARRA) and the massive investment made by several federal agencies over the next five years. Sadly, he is not exaggerating at all. What a sad reality, but why overhaul the entire system from the foundation up without first assessing the impact of this $58B+ investment on the physicians and their willingness to adapt to the 21st century?

Why is "insurance reform" more important that tort reform? You cannot even put the health care business in the same league as the grocery sector when it comes to information technology adoption, the single greatest factor in the cost savings and productivity increases across nearly every other sector of the American economy for the last 15 years, but we can somehow call it a failed industry and support wholesale restructuring??

GOP releases colorful interpretation of Democrats ridiculous health care reform proposal

briantedwards@gmail.com (Brian T. Edwards) — Wed, 15 Jul 2009 19:40:30 PDT

House Democrats Health Plan Illustration

HR 3200: America’s Affordable Health Choices Act of 2009 (Full Text)

briantedwards@gmail.com (Brian T. Edwards) — Tue, 14 Jul 2009 22:03:18 PDT

Below is the final proposal for health care reform issued by the Democratic House of Representatives today, which Speaker Nancy Pelosi confidently asserted she could pass by the end of the summer session. That's right, we only have about four weeks to digest, debate, amend and vote on this 1018-page piece of legislation which seeks to fundamentally redefine the rules of our nation's largest industry. Turns out "change" sucks a whole lot more than the status quo sometimes.

Would love to hear everyone's thoughts...

HR 3200 - America’s Affordable Health Choices Act of 2009

ASCAP calls music ringtones "performances" and wants you to pay...

briantedwards@gmail.com (Brian T. Edwards) — Thu, 02 Jul 2009 22:30:55 PDT

In a brief filed by the American Society of Composers, Authors and Publishers (ASCAP) against AT&T Wireless and Cingular Wireless, ASCAP argues that the music ringtones that you have on your cell phone should be considered "performances" and that they should be compensated each time your phone rings. See the first PDF below for the full text of the brief, courtesy of BetaNews.

So not only will these ringtones continue to annoy the hell out of those of us who have to hear them every time someone next to us on the train gets a phone call, but the fact that we are present to be annoyed in the first place might end up causing that person money because of the performance we were forced to endure against our will!!

The absurdity of the logic underlying this brief is hilarious on its face, but I cannot wait to read the ruling from the District Court judge on whether or not this is a legitimate claim. I mean, didn't a jury recently award a seven figure judgement against a single mother for downloaded a few dozens tracks years ago? I wouldn't put it past the screwed up legal system of this country to actually find in favor of ASCAP.

Fortunately, the ASCAP suit has no intention of shaking down normal folks who's only crime is their total lack of consideration for those around them. Rather, the suit seeks to force the wireless providers to pony up millions on their customer's behalf; costs which would simply be passed along to consumers in the form of higher monthly bills. That's right, even those of us who don't use obnoxious ringtones will be forced to subsidize our annoying family, friends and neighbors who do if this suit is successful.

The second brief embedded below was filed Wednesday by the Electronic Frontier Foundation in response to the ASCAP suit. It dismisses the ASCAP suit as "outlandish", but the arguments made to support this dismissal are weak at best. It claims that under the logic of the claim, ASCAP could sue people for listening to their car stereos loudly with the windows open so a passersby could hear the music. However, in that case the music being played is sanctioned by ASCAP because either the radio station broadcasting the song is paying for its distribution. It would be accurate to argue that the music in the car might have been downloaded illegally and played without proper legal rights, but the offense in that scenario would be the illegal file sharing, which would supersede any violation of fair use that may be asserted by the publishers.

After brief consideration I am far from convinced that ASCAP does not have a case, but I am interested to hear what others have to say. Clearly the debate is still fresh so please share your thoughts!

ASCAP's Opposition to AT&T's MSJ Ringtones

Us v Ascap Eff Att Brief

Exclusive Iraq oil deals go to Chinese and British...

briantedwards@gmail.com (Brian T. Edwards) — Tue, 14 Jul 2009 21:11:46 PDT

It was very encouraging to see Iraq award exclusive oil deals to British Petroleum (BP) and China National Petroleum Company (CNPC) for the right to work in the Rumaila Field, the country's largest known oil field in Iraq with 17 Billion barrels in reserves. I say this not because I am happy the contracts were not awarded to American firms (ideally they would have been), but rather because it speaks volumes about the current stability of the war torn country's core infrastructure and its prospects for success moving forward independently in a global economic environment.

The Chinese are typically willing to brave dangerous conditions to access valuable natural resources and CNPC is perhaps among the most successful energy companies in the world when it comes to managing production in turbulent environments, evidenced by their unwavering commitment to facilities in much less stable regions like The Sudan. Critical to the CPNC strategy is employing as many locals as possible and supplying the communities surrounding its projects with large non-energy related aid and resources, such as medical supplies and support for education programs that go above and beyond the typical multi-national corporate agenda.

I have long argu ed that the China model for growing economies in Africa and the Middle East is far superior to the Western models. This is primarily because it relies on social/human capital and the ability to embed its culture and expertise on the ground in large numbers of human bodies, rather than the default Western strategy of distributing vast amounts of monetary aid according to complex economic formulas developed by elite Western academics totally removed from the reality of the conditions taken into consideration.

Dambisa Moyo (@dambisamoyo) has recently made serious waves among elite Ivy thinkers with a new paradigm for Western aid to Africa which is founded on her personal experiences as a child of Africa and as a student of the finest Western institutions and as a distinguished economist at the most powerful/respected investment bank in the world - a truly unique perspective that must not be diminished. She too has recognized the value proposition of a highly engaged Chinese presence in developing nations in Africa and I suspect would extend this recognition to a similar role for the Chinese in Iraq and other struggling (but promising) Middle Eastern economies. I commend Ms. Moyo for her courage and hope she will continue to fight against the intellectual mainstream, because in the end she (and I) will be vindicated by the results of powerful ideas.

Readthebill.org: Sunlight Foundation Project Pushes for Mandatory 72-hour Period for Congress to Read Bills Before Voting

briantedwards@gmail.com (Brian T. Edwards) — Wed, 01 Jul 2009 01:23:03 PDT

Readthebill.org is a Sunlight Foundation Project lobbying for a mandatory 72-hour period between the close of debate on a particular piece of legislation and the and the final vote on passage. The project was born out of the frustration felt by nearly all Americans when it became blatantly apparent that none of the members in either the House or Senate have read the legislation they have so confidently and indignantly voted up or down.

The most recent example of this came just last week when the House passed a pathetic Climate Change Bill which had a 300+ page amendment attached at 3am on the morning of the final vote, which clearly none of the members (with the exception of Minority Leader John Boehner, who stood in filibuster on the house floor before the ultimate vote and read aloud the most ridiculous additions) had actually taken the time to read.

I say READ THE DAMN BILL, its your job!!! Hopefully these idiots in Washington don't f@#$ up the system too bad before the next generation of leaders have their say, though I am not too optimistic, as our problems seem to only get worse every time our "leaders" in Washington do anything to address them.

Final draft of proposed financial regulatory reforms released today...

briantedwards@gmail.com (Brian T. Edwards) — Tue, 30 Jun 2009 07:49:51 PDT

Below I have embedded the final 89 page report, found at FinancialStability.gov, which outlines the scope of reforms sought by the the Obama Administration to the financial system. The highly respected appeals court judge Richard Posner just slammed the report as dripping with "Roosevelt envy" on CNBC, but having clearly not read it yet I will reserve my personal opinion for a later date. Comments welcome and encouraged.

Financial Regulatory Reform

Obama speech endorsing indefinite detentions for "preventive" purposes...

briantedwards@gmail.com (Brian T. Edwards) — Mon, 29 Jun 2009 08:51:29 PDT

Rachel Maddow is a very liberal political commentator on MSNBC who typically gives Barack Obama the benefit of the doubt on everything he says/does. However, in her reporting of President Obama's speech at the National Archives in late May regarding President Bush's "ad hoc legal framework" for indefinite detentions of POWs at Guantanamo Bay she does her fellow liberals, and all Americans for that matter, a great service by reading through Obama's B.S.

In his speech, after artfully chastising the Bush Administration's alledgedly unconstitutional policies, the president argues for establishing what amounts to an ad hoc legal framework for PREVENTIVE INDEFINITE DETENTIONS!! The only real distinction between Bush's policy and Obama's would be that Bush detained indefinitely for crimes committed, while Obama would indefinitely detain for crimes to be committed one day. Watch this video and hear it from straight from Maddow herself...

Draft of Obama's Regulatory Revamp

briantedwards@gmail.com (Brian T. Edwards) — Wed, 17 Jun 2009 22:01:56 PDT

Today was a truly historic day for the financial industry as President Obama released his long anticipated plan for overhauling the financial regulatory system. Embedded below is a draft of this plan. I would love to hear what everyone thinks.

Obama's Financial Sector Reform Proposal

Kennedy-Dodd Health Reform Bill: Mandates and Subsidies

briantedwards@gmail.com (Brian T. Edwards) — Tue, 16 Jun 2009 02:00:19 PDT

Below I have shared a terrific outline of the Democratic health care reform package, which has been dubbed the Kennedy-Dodd Health Care Reform Bill, as it currently reads. The outline was written by Keith Hennessey and makes several very excellent points about the truly disruptive nature of this legislation, which is supported by the president, were it to pass in its current form. I have also embedded the full text of the bill as it exists today for those of you who are interested.

KeithHennessey.com » Understanding the Kennedy health care bill

Here are 15 things to know about the draft Kennedy-Dodd health bill.

The Kennedy-Dodd bill would create an individual mandate requiring
you to buy a “qualified” health insurance plan, as defined by the
government. If you don’t have “qualified” health insurance for a given
month, you will pay a new Federal tax. Incredibly, the amount and
structure of this new tax is left to the discretion of the Secretaries
of Treasury and Health and Human Services (HHS), whose only guidance is
“to establish the minimum practicable amount that can accomplish the
goal of enhancing participation in qualifying coverage (as so
defined).” The new Medical Advisory Council (see #3D) could
exempt classes of people from this new tax. To avoid this tax, you
would have to report your health insurance information for each month
of the prior year to the Secretary of HHS, along with “any such other
information as the Secretary may prescribe.”

The bill would also create an employer mandate. Employers would
have to offer insurance to their employees. Employers would have to
pay at least a certain percentage (TBD) of the premium, and at least a
certain dollar amount (TBD). Any employer that did not would pay a new
tax. Again, the amount and structure of the tax is left to the
discretion of the Secretaries of Treasury and HHS. Small employers
(TBD) would be exempt.

In the Kennedy-Dodd bill, the government would define a qualified plan:
1. All health insurance would be required to have guaranteed issue and
  renewal, modified community rating, no exclusions for pre-existing
  conditions, no lifetime or annual limits on benefits, and family
  policies would have to cover “children” up to age 26.
2. A qualified plan would have to meet one of three levels of
  standardized cost-sharing defined by the government, “gold, silver, and
  bronze.” Details TBD.
3. Plans would be required to cover a list of preventive services approved by the Federal government.
4. A qualified plan would have to cover “essential health benefits,” as defined by a new Medical Advisory Council (MAC),
  appointed by the Secretary of Health and Human Services. The MAC would
  determine what items and services are “essential benefits.” The MAC
  would have to include items and services in at least the following
  categories: ambulatory patient services, emergency services,
  hospitalization, maternity and new born care, medical and surgical,
  mental health, prescription drugs, rehab and lab services,
  preventive/wellness services, pediatric services, and anything else the
  MAC thought appropriate.
5. The MAC would also define what “affordable and available coverage”
  is for different income levels, affecting who has to pay the tax if
  they don’t buy health insurance. The MAC’s rules would go into effect
  unless Congress passed a joint resolution (under a fast-track process)
  to turn them off.
Health insurance plans could not charge higher premiums for risky
behaviors: “Such rate shall not vary by health status-related factors,
… or any other factor not described in paragraph (1).” Smokers,
drinkers, drug users, and those in terrible physical shape would all
have their premiums subsidized by the healthy.

Guaranteed issue and renewal combined with modified community
rating would dramatically increase premiums for the overwhelming
majority of those Americans who now have private health insurance. New
Jersey is the best example of health insurance mandates gone wild. In
the name of protecting their citizens, premiums are extremely high to
cover the cross-subsidization of those who are uninsurable.

The bill would expand Medicaid to cover everyone up to 150% of
poverty, with the Federal government paying all incremental costs (no
State share). This means adding childless adults with income below
150% of the poverty line.

People from 150% of poverty up to 500% (!!) would get their health
insurance subsidized (on a sliding scale). If this were in effect in
2009, a family of four with income of $110,000 would get a small
subsidy. The bill does not indicate the source of funds to finance
these subsidies.

People in high cost areas (e.g., New York City, Boston, South
Florida, Chicago, Los Angeles) would get much bigger subsidies than
those in low cost areas (e.g., much of the rest of the country,
especially in rural areas). The subsidies are calculated as a
percentage of the “reference premium,” which is determined based on the
cost of plans sold in that particular geographic area

There would be a “public plan option” of health insurance offered
by the federal government. In this new government health plan, the
federal government would pay health care providers Medicare rates +
10%. The +10% is clearly intended to attract short-term legislative
support from medical providers. I hope they are not so naive that they
think that differential would last.

Group health plans with 250 or fewer members would be prohibited from self-insuring. ERISA would only be for big businesses.

States would have to set up “gateways” (health insurance exchanges)
to market only qualified health insurance plans. If they don’t, the
Feds will set up a gateway for them.

Health insurance plans in existence before the law would not have
to meet the new insurance standards. This creates a weird bifurcated
system and means you would (probably) be subject to a different set of
rules when you change jobs.

The bill does not specify what spending will be cut or what taxes
will be raised to pay for the increased spending. That is presumably
for the Finance Committee to determine, since it’s their jurisdiction.

The bill defines an “eligible individual” as “a citizen or national
of the United States or an alien lawfully admitted to the United States
for permanent residence or an alien lawfully present in the United
States.”

The bill would create a new pot of money for state gateways to pay
“navigators” to educate people about the new bill, distribute
information about health plans, and help people enroll. Navigators
receiving federal funds “may include … unions, …”

This would have severe effects on the more than 100 million Americans who have private health insurance today:

The government would mandate not only that you must buy health insurance, but what health insurance counts as “qualifying.”

Health insurance premiums would rise as a result of the law, meaning lower wages.

A government-appointed board would determine what items and
services are “essential benefits” that your qualifying plan must cover.

You would find a tremendous new disincentive to switch jobs,
because your new health insurance may be subject to the new rules and
would therefore be significantly more expensive.

Those who keep themselves healthy would be subsidizing premiums for those with risky or unhealthy behaviors.

Far more than half of all Americans would be eligible for subsidies, but we have not yet been told who would pay the bill.

The Secretaries of Treasury and HHS would have unlimited discretion
to impose new taxes on individuals and employers who do not comply with
the new mandates.

The Secretary of HHS could mandate that you provide him or her with “any such other information as [he/she] may prescribe.”

Kennedy-Dodd Health Care Reform Bill (First Draft)

Publish at Scribd or explore others: Law & Government Business & Law kennedydodd health c christopher dodd

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Health Care Information Technology Must Come First

briantedwards@gmail.com (Brian T. Edwards) — Mon, 08 Jun 2009 10:06:38 PDT

President Obama has made no secret of his desire to forge ahead with ambitious health care reform legislation despite the economic crisis and soaring current account deficits with no end in sight. Obama wear's his philosophy on his sleeve: health care reform will be a central and unavoidable precursor to tightening federal spending over the long-term. I believe the president is absolutely correct, but I think he is putting the cart before the horse if he tries to overhaul the marketplace for health care providers before fully investing in and committing to the development of a nationwide health information technology foundation.

Information technology has transformed the fabric of civilization and industry in the US and around the world in ways unimaginable even 10 years ago. For the first time in history information is truly ubiquitous and free flowing. However, the largest US industry, Health Care, has largely failed to adopt IT in any meaningful way to enhance the quality of care received by patients. Despite this fundamental fallacy amongst health care providers, little more than token recognition has been paid to the matter by federal policymakers until very recently.

The recent American Recovery and Reinvestment Act (ARRA) was the first major federal injection of long-term capital ($48B+ over five years) into developing health IT infrastructure that is likely to have a real impact on patient outcomes. Physicians are offered real (though inadequate) incentives to adopt electronic health records and states are provided a true capital foundation upon which the technologies needed to expand coverage and value penetration. The stimulus funds are to be administered primarily by the newly formed Office of the National Coordinator (ONC) for Health Information Technology in the Department of Health and Human Services (HHS). However, it seems unlikely that this communications technology will be quickly adopted by providers and physicians, both of whom still lack any meaningful incentive to change.

I believe strongly that the marketplace for health insurance cannot experience fundamental reform until the broader health care industry has adopted the most basic value-added information technologies into the care delivery cycle and the true impact of this information flow on the quality of care can be quantified. To attempt radical health reform before this has been accomplished would be like prescribing treatment for a disease before assessing the patient's symptoms and issuing a diagnosis.

President Obama has a mandate to make sweeping changes to the way America is governed, this cannot be denied, and he appears to be intently focused on doing just that during the first two year of his presidency. It would be unfortunate if his party's legislative supramajority and his own impatience for gradual reform lead him to lose touch with realities of his capabilities as a mere mortal. Don't forget Mr President, "All glory is fleeting".

Weekly Address: President Obama Calls for Real Health Care Reform

The Coming Collapse of America: Understanding the scope of US entitlements

briantedwards@gmail.com (Brian T. Edwards) — Fri, 05 Jun 2009 06:10:42 PDT

For those of you that love reading about the impending collapse of our great country, here is an article from Forbes about two weeks back that summarizes the findings of two Federally conducted audits of the outstanding liabilities for both Social Security and Medicare/Medicaid, each released in the past few weeks. The first report was prepared by the Social Security Administration, and the second by the Dept of Health and Human Services. I just want to make sure everyone is clear and fully informed about the reality of the situation before we proceed with these conversations.

I hate to tell everyone, but the conclusion of these non-partisan reports make it clear that nothing is impossible when it comes to the Federal government making promises it can keep. The only clever way to fix problems as big as these is to either cut liabilities (LOL) or radically increase taxes. To fully off-set the liablities acknowledged in these reports, every American's welfare contributions would have to be increased 81% every year forever.

To quote the Forbes piece:

To put it another way, the total unfunded indebtedness of Social Security and Medicare comes to $106.4 trillion. That is how much larger the nation's capital stock would have to be today, all of it owned by the Social Security and Medicare trust funds, to generate enough income to pay all the benefits that have been promised over and above future payroll taxes. But the nation's total private net worth is only $51.5 trillion, according to the Federal Reserve. In effect, we have promised the elderly benefits equal to more than twice the nation's total wealth on top of the payroll tax.

Of course, theoretically, benefits could be cut to prevent the necessity of a massive tax increase. But how likely is that? The percentage of the population that benefits from Social Security and Medicare is growing daily as the baby boom generation ages and longevity increases. And the elderly vote in the highest percentage of any age group, so their political influence is even greater than their numbers.

It is easy to dismiss Wikipedia, but these numbers are all too real and there is not a damn thing Obama has/will do about it because he doesn't really care about young Americans, he cares about getting elected and he knows damn well every stupid 20-30 year-old voter, even those with college educations, will probably vote for him no matter what he does for us because (a) its "cool", (b) none of my peers have any concept of BULL SHIT, or (c) everyone under 30 really doesn't care if their future is taken into consideration by policymakers.

Unless Obama does something to start correcting these shortfalls, yes you guessed it, we will continue to get f***ed by our parents even after they are long when the government they left us collapses under it's obligations. By that time, we can point fingers at nobody but ourselves because it seems unlikely we will do anything to help our own cause.

How long will FDIC be able to guarantee deposits?

briantedwards@gmail.com (Brian T. Edwards) — Mon, 01 Jun 2009 14:25:04 PDT

The FDIC deposit insurance fund, which was featured on 60 minutes this weekend, has never allowed a depositor to lose even one penny of guaranteed deposits. Currently deposits are guaranteed up to $250,000 in all FDIC insured institutions. This insurance has to this point been funded entirely by the banking industry, as opposed to the Federal printing press, this may be on the verge of a tipping point. Imagine the panic in the streets if the FDIC is even perceived to be slightly vulnerable to the shocks in the small to mid cap domestic banking market, which has already experienced 30 seizures this year, over a dozen more than last year and we are exactly halfway through the Hell of 2009 today.

Chart and comment below from Tyler Durden of Zero Hedge, my favorite finance blog, and probably favorite financial news source period.

The FDIC's Deposit Insurance Fund has plunged to an all time low of just $13 billion as of March 31, or 0.27% of $4.8 trillion in insured deposits. It is worth nothing that since March 31, 15 new banks have failed which includes the biggest one so far this year, BankUnited (which Marla has a special fondness for in her heart and will be providing some ongoing entertainment on). It is thus safe to say that the $13 billion has been spent in the past 2 months, especially since banks no longer issue debt under the TLGP (of which, nonetheless, there was $336 billion outstanding at March 31 - somehow when banks are talking about repaying TARP, their FDIC-guaranteed debt, by far the biggest crutch to the banking system, is conveniently never mentioned) and therefore no longer pay FDIC guaranteed debt issuance associated fees. For many more thoughts on this phenomenon, go here.

Also, DIF-Insured deposits have hit an all time record high of $4.8 trillion, an increase of $90 billion from December 31 as depositors have been seeking a safe haven from the market in Q1. It is unknown if they would have done so, had they known their "insured" deposits will cover only the first 0.27% of depositors if there is another bank failure tsunami. As there is only one more month left in Q2 it will be curious to see it there will be a rotation out of deposits into investments at June 30, concurrent with the time we will know what the current level on the DIF is. Of course, as this data will be available some time in September, by then it may be completely worthless as one would imagine at some point the mystical futures buying force, end of month convenient fund deleveraging, or whatever else you want to call it, will have finally exhausted its market pulling strength.

Blog Rally: Raising Awareness for Public Participation in Healthcare X PRIZE Development

briantedwards@gmail.com (Brian T. Edwards) — Mon, 01 Jun 2009 07:18:14 PDT

Blog Rally (b’lôg răl’ē) adj.

A coordinated, simultaneous presentation of identical or similar material on numerous blogs for the purpose of engaging large numbers of readers and/or persuading them to adopt a certain position or take a certain action.
The simultaneous nature of a blog rally can create the result of joining the efforts of otherwise independent bloggers for an agreed-upon purpose.

We are entering an unprecedented season of change for the United States health care system. Americans are united by their desire to fundamentally reform our current system into one that delivers on the promise of freedom, equity, and best outcomes for best value. In this season of reform, we will see all kinds of ideas presented from all across the political spectrum. Many of these ideas will be prescriptive, and don’t harness the power of innovation to create the dramatic breakthroughs required to create a next generation health system.
We believe there is a better way.
This belief is founded in the idea that aligned incentives can be a powerful way to spur innovation and seek breakthrough ideas from the most unlikely sources. Many of the reform ideas being put forward may not include some of the best thinking, the collective experience, and the most meaningful ways to truly implement change. To address this issue, the X PRIZE Foundation, along with WellPoint Inc and WellPoint Foundation as sponsor, has introduced a $10MM prize for health care innovators to implement a new model of health. The focus of the prize is to increase health care value by 50% in a 10,000 person community over a three year period.
The Healthcare X PRIZE team has released an Initial Prize Design and is actively seeking public comment. We are hoping, and encouraging everyone at every opportunity, to engage in this effort to help design a system of care that can produce dramatic breakthroughs at both an individual vitality and community health level.
Here is your opportunity to contribute:

Download the Initial Prize Design
Share you comments regarding the prize concept, the measurement framework, and the likelihood of this prize to impact health and health care reform.
Share the Initial Prize Design document with as many of your health, innovation, design, technology, academic, business, political, and patient friends as you can to provide an opportunity for their participation

We hope this blog rally amplifies our efforts to solicit feedback from every source possible as we understand that innovation does not always have a corporate address. We hope your engagement starts a viral movement of interest driven by individual people who realize their voice can and must be included. Let’s ensure that all of us – and the people we love – can have a health system that aligns health finance, care delivery, and individual incentives in a way that optimizes individual vitality and community health. Together, we can ensure the best ideas are able to come forward in a transparent competition designed to accelerate health innovation. We look forward to your participation.

Special thanks to Paul Levy for both demonstrating the value of collaborative effort and suggesting we utilize a blog rally for this crowdsourcing effort. Participating bloggers and media include include:

Bob Coffield, Health Law Blog
Richard Elmore, Avance Healthcare
Vijay Goel, MD - Consumer Focused Healthcare
Vince Kuraitis, eManagement Blog
Paul Levy, Running a Hospital
Bertalan Mesko, Science Roll
Modern Healthcare
Bill Pomerantz, The Launch Pad
Amy Tenderich, Diabetes Mine
Fred Trotter, Open Source Hacktavist
Matthew Holt, The Healthcare Blog

HXP - Initial Prize Design_v1

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Restoring Perspective: Damn You Baby Boomers

briantedwards@gmail.com (Brian T. Edwards) — Mon, 01 Jun 2009 18:22:04 PDT

The root of the 'too big to fail' argument extends back to the Bear Stearns fire sale to Chase and the subsequent liquidity injections for Freddie and Fannie. This should have been evident to everyone when Dick Fuld, CEO of Lehman Brothers, clearly expected to receive a bailout or forced acquisition from his former rival and fellow investment banker Hank Paulson, only to be shown the door by a devilishly righteous Treasury Secretary when zero hour struck.

The grin was wiped off Henry's face seemingly overnight, and all of a sudden we had TARP and 'toxic' aka 'distressed' aka 'legacy' assests that the Federal government desperately needed $700B overnight to purchase all of these rotten investments from the banks before the world was going to end. You can, and should, read documents recently made public in a Freedom of Information Act challenge by Judicial Watch to get a full appreciation for the both the tremendously historic nature of the TARP program, as well as the cavalier attitudes taken by those charged with its design.

Here we find our selves in retrospect with the terms 'too big to fail' or 'systemically critical' becoming matters of daily business in DC, I think everyone needs to watch this FRONTLINE episodes "Inside the Meltdown" and "Ten Trillion and Counting" to get a refresher on exactly the extent of our obligations and the blatant disregard for long-term sustainability demonstrated by policymakers. As it turns out failure during tough times is every bit as critical to survival of our capitalist system as success and prosperity during boom times.

I blame it all on the irresponsible and self-absorbed baby boomers. I look forward to the day when our parent's generation can no longer find a job because their skills are useless, which should be around the same time our government finally acknowledges that Social Security is gone and never coming back just like their 401k and eTrade account.

As long as the members of the UAW don't suffer hard times today, the rest of us won't be too pissed off at the government when that inevitable day does arrive, right?? Screw the unions, screw the banks, screw the newspapers; let them fail and hope they drag their irresponsible middle-aged managers right out of the workforce with them because their salvation is coming at the expense of our civilization's slow and painful demise.

Behind the Financial Bailout: Treasury documents and internal e-mails in the days before TARP

briantedwards@gmail.com (Brian T. Edwards) — Mon, 01 Jun 2009 18:22:04 PDT

There are few weeks in American history as epic and significant as those leading up to TARP. See the embedded document below, courtesy of Zero Hedge, for a glimpse into the Treasury Department managed by an Investment Banker and judge for yourself the historical implications.
Treasury CEO Talking Points v1

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The World We'll Inherit

The legislative landscape for health care after House passage | KeithHennessey.com

Pivot points and the importance of recess

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Conference or ping pong?

My projections

KeithHennessey.com » The legislative landscape for health care after House passage » Print

Pivot points and the importance of recess

The three-part strategic question

Conference or ping pong?

My projections

KeithHennessey.com » The legislative landscape for health care after House passage » Print

Pivot points and the importance of recess

The three-part strategic question

Conference or ping pong?

My projections

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Behind the Financial Bailout: Treasury documents and internal e-mails in the days before TARP