WVHCA Board Approves Modified Cardiac Catheterization Standards

Yesterday, the West Virginia Health Care Authority Board approved the changes to the Certificate of Need Standards for Cardiac Catheterization. The approved modification will now be delivered to Governor Manchin for review and approval.

Eric Eyre of the Charleston Gazette covers the story today in his article, Smaller hospitals get OK to offer heart procedures.

The new Standards will not go into effect until approved by the Governor. The current Cardiac Catheterization Standards were last updated and approved by the Governor on May 3, 2007.

For more on the process of modifying the standards check out my previous posts.

Better Understanding of Key Health Information Technology Terms

On April 28, 2008, the National Alliance for Health Information Technology released its Report, "Defining Key Health Information Technology Terms," to the Office of the National Coordinator for Health Information Technology.

The report is an effort to get everyone working in health information technology to have a common understanding of and differences between EMRs, EHRs, PHRs, HIEs, HIOs and RHIOs. If you don't know what each of these are or are interested in better understanding these key health tech terms check out the report.

An article by Health Data Management indicates that the Report will be "presented on June 3 to the American Health Information Community, a Department of Health and Human Services advisory body, for final approval."

The Health of Google and Google Health

Very interesting post over at ZDNet by Tom Foremski on an upcoming meeting of Google hacks at the Googleplex set for May 19.

Fascinating description of Google's use of machines and software to produce results rather than humans and how this might exist in the health care environment. I have not heard of this description of what Google does and why it does it better and cheaper.

Also, he offers compelling thoughts on the pharma advertising market target that Google may be looking for as it goes about developing Google Health.

Tip to the NewsGang Twitter feed.

The momScore: How West Virginia Ranks For Maternal Health

While reading this week's Grand Rounds hosted this week at Suture for a Living, I jumped over to an interesting post by Dr. Val on an effort by her and Revolution Health to team up with medical experts and mommy bloggers to create a new health index for Mother's Day.

West Virginia ranks 38 out of 51 states on the momScore. As we head into this weekend's Mother's Day, Anna Marie Jarvis would want us to try to raise our ranking. I'm issuing a challenge to all West Virginia health care providers to think about and work on improving these statistics and metrics.

West Virginia received a a score of 69 out of a possible 100. The areas used for the ranking include: access to prenatal care, air quality, availability of childcare services, family paid leave policy, health care coverage rate, infant mortality, maternal mortality, risk of pregnancy complications, affordability of children's health insurance and violent crime rate.

If you want to discuss or debate West Virginia's rankings you can post your comments on the interactive momScore community.

Grand Rounds . . . Revolution

Grand Rounds Volume 4, No. 19 is up over at my favorite nurse blog, Emergiblog. Kim has wonderful vision into the world of health care and is a creative writer to boot.

I've gotten out of the habit of submitting posts to Grand Rounds. Never enough time in the day. However, I wish I would have submitted my Guitar Hero Health Care post from this week -- it would have fit well in her Beatles theme. Find the Beatles link in my post.

Maybe I'll email Kim as see if she will give me a Grand Rounds postscript note.

Get Your Google Health . . . Soon

Various reports out about the coming of Google Health. As Matthew Holt indicates, the Google purists found a log in page (screen shot).

The log in page has since been pulled down but Matthew and Tech Crunch provide a list of what the log in page said Google Health will do for you, including:

With Google Health, you can:

• Build online health profiles that belong to you
• Download medical records from doctors and pharmacies
• Get personalized health guidance and relevant news
• Find qualified doctors and connect to time-saving services
• Share selected information with family or caregivers

I'm particularly interested to check out the "Google Health Privacy Policy" which is referenced on the log in screen shot.

Stay tuned . . .

Guitar Hero Health Care

Guitar Hero (Rock Band) Health Care. The current (next) generation expects to be on the stage performing and not just sitting passively in the audience.

Check out Why Consumer - Directed Medicine, Health 2.0 Will Flourish by Jen McCabe Gorman at Health Management RX.

What the coming generation will expect from providers - read Jen's questions and formulate your answer. The task we all have in front of us is how to harness these mentoring powers to focus on preventative care, disease management and wellness.

She ends with:

Work on mentoring the 'me' generations - the next wave of healthcare delivery will depend on carefully mentoring 'me' thinkers to manage personal responsibility and maintain individual health. Wellness maintenance programs are just one part of the solution . . .

. . . Give us a solo - we've been taught for most of our lives to tell people what we want. You've been taught for most of your lives to tell people what we need to be well. Your answers about how to work with us in the new system are waiting.

WVHCA: Update on the Proposed Cardiac Catheterization Standards

I previously posted about the proposed amendments to the Certificate of Need Cardiac Catheterization Standards issued by the West Virginia Health Care Authority for public comment.

Today, Charleston Gazette reporter, Eric Eyre, reports on the current debate over the standards. To learn more you can read the comments submitted regarding the proposed standards.

President-Elect of American Medical Association

Congratulations to Elkins, West Virginia native, Nancy J. Nielsen, M.D., Ph.D., president-elect of the American Medical Association. Dr. Nielsen will only be the second female to hold the position. Another example of a West Virginian making great strides in health care and medicine.

More of the story from today's Charleston Daily Mail. AMA press release dated June 23, 2006.

WVHCA Reconsiders HCR Manor Care CON

The State Journal provides background on the pending reconsideration hearing set for December 14, 2007 (9am), before the the West Virginia Health Care Authority regarding the Authority's granting of a certificate of need for the $6.3 billion buyout of HCR Manor Care by The Carlyle Group, a private global investment firm.

The Authority granted HCR Manor Care a certificate of need on October 19, 2007, however, on November 15 the Service Employees International Union Local 1199 filed a Request for Reconsideration with the Authority along with an Appeal to the Office of Judges.

On November 20, the Authority issued its Decision on Request for Reconsideration granting the reconsideration and ordering a stay of its October 19, 2007 decision pending resolution of the request for reconsideration.

UPDATE (12/10/07): Jeff Mehalic at the West Virginia Business Litigation blog picks up on my post and includes uploaded links of some of the CON pleadings in the matter, including the:

• Authority's October 19, 2007 CON Decision approving the merger between Manor Care and Carlyle Group
  
• SEIU District 1199's Request for Reconsideration
• the Authority's Decision on Request for Reconsideration granting reconsideration, a hearing on the reconsideration and a stay of its October 19 Decision and
  
• the Amended Notice of Administrative Hearing set for December 14.

Thanks to Jeff for the link and for uploading some of the key public documents in this pending certificate of need matter.

WV Rolls Out BMI Wheel Project

West Virginia and Unicare rolls out a simple solution to fighting the obesity problem in West Virginia (WV ranks as the #3 heaviest state). The project involves giving West Virginia physicians a small body mass index (BMI) calculator wheel and training in how to use the wheel to recognize obesity earlier, especially in children.

Thanks to Jane Sarasohn-Kahn at Health Populi for the tip on the project.

New Health Care CIO Blog

A welcome to John Halamka, MD and CIO of CareGroup Health System and the Chief Information Officer and Dean for Technology at Harvard Medical School who has launched a new blog, Life as a Healthcare CIO. Dr. Halamka is also the Chairman of the New England Health Electronic Data Interchange Network (NEHEN), CEO of MA-SHARE (the Regional Health Information Organization), Chair of the US Healthcare Information Technology Standards Panel (HITSP), and a practicing Emergency Physician.

His tag line says:

Every day I experience life in the world of healthcare IT, supporting 3000 doctors, 18000 faculty, and 3 million patients. In this blog I record my experiences with infrastructure, applications, policies, management, and governance as well as muse on such topics such as reducing our carbon footprint, standardizing data in healthcare, and living life to its fullest.

Check out the great content in these recent posts, Top 10 Things a CIO Can Do to Enhance Security and the pro/cons of Flexible Work Arrangements. Looking forward to reading more of his posts. Tip to David Williams at Health Business Blog for pointing out this new health care CIO blog.

Now Playing . . . The Digital Health Revolution

Friend and fellow health care blogger, Fard Johnmar, today officially announced the launch of The Digital Health Revolution. A project he has been working on with the folks at Scribe Media since meeting them at the fHealthcare Blogging Summit in Las Vegas.

Fard has great insight into the health care industry and I look forward to great content coming out of DHR. Check out the show here, including a very interesting interview with Susannah Fox, Associate Director with the Pew Internet and American Life Project on the topic of empowerment/revolution of the e-patient.

Enoch Choi, MD and I were lucky enough to be Fard's guinea pigs in his first (impromtu) interview for Scribe Media.

HealthVault: Adding Structure (Interoperability) to the Health Information Ecosystem

Last week (October 4) Microsoft rolled out a brand new vehicle that should help accelerate the growing consumer driven health care movement and creation of a national interoperable health information system. HealthVault is a new personal health record (PHR) platform that allows the user to gather, store and share health information online.

There has been a lot written about the roll out of HealthVault over the last week. I've read numerous articles and blog posts to try to get a better grasp of what it is (and what it is not). Over the weekend I ran across Vince Kuraitis' post at his e-CareManagement Blog which I found to have provided some good insight. Not until reading Kuraitis' post did I actually understand that HealthVault is not a PHR but a PHR platform.

In particular I like this quote by Kuraitis and his comparison of the pre-fax world:

" . . . this really isn’t about Microsoft vs. Google . . . It’s about creating a new business ecosystem based on the appropriate (honoring privacy and security) free flow of interoperable and transportable personal health information (PHI) — something that doesn’t exist today."

I'll throw out another comparison that I thought about as I read his post -- the natural gas transportation and storage industry. West Virginia is home to some large underground gas storage facilities. Basically, natural gas is pumped during off season to West Virginia from the Gulf Coast via large transmission lines or is gathered from small wells through gathering facilities and lines. The gas is then pumped and stored in previously depleted underground wells. In doing so, the natural gas can be stored safely and moved quickly to market in the northeast during the cold months.

HealthVault is setting out the same architecture, transportation and storage device for health information. The natural gas (health information) is very valuable and the system of moving it around is incredibly complex with multiple players and competitors. You have individuals and companies constantly adding natural gas (health information) to the system and end users who need natual gas (health information) at the opposite end. To date the health care industry does not have such a structured, standardized system of pipelines to protect and transport health information. We are largely still living in a paper world with systems that don't have the capability to talk to each other.

As I step back and take a look -- I see an industry in the midst of a tidal shift regarding the control of personal health information and maybe the bigger question of who wants (and can safely) control health information. Microsoft's HealthVault appears to be laying down more planks to create the platform for an interoperable system that will allow for health information to become more transportable, transparent and standardized. Ultimately, the question in my mind remains whether this will help to improve care and help each of us become better stewards of our own health?

Stay tune . . .

Health 2.0 Physician Model: House Calls and FICO

Just back from Health 2.0 and was reading about Dr. Parkinson who demonstrates his new (disruptive) model changing the way health care is provided. Don't miss the great discussion in the comments. Check out Dr. Parkinson's website Jay Parkinson, MD + MPH (and his blog).

Dr. Parkinson's approach also highlights something of value that I think has been missing from health care for years -- house calls. I had the chance to watch and go on house calls with my dad, a retired rural physician. There is incredible value in seeing the patient in his/her own environment.

Dr. Parkinson's response in the comments is a concrete example of Scott Shreeve's FICO concept discussed at Health 2.0. Dr. Parkinson comment:

"I’m also toying with the possibility of lowering the following year’s fee for each individual who utilizes my services less often than average. We’ll see."

Update: Catch an interview with Dr. Parkinson who explains his business mode on ABC News.

2007 Healthcare Blogospere Survey

A few weeks ago my fellow blogging colleague, Fard Johnmar, announced the second edition of Taking The Pulse Of The Healthcare Blogosphere (2007 Survey). A survey co-produced by Johnmar's Envision Solutions and Trusted.MD Network.

The survey was first conducted last year (read the highlights). The survey will again look at the trends of health care bloggers so that we can all better understand why people blog about health and medical topics.

Today I finally got around to taking the survey and am passing along a recommendation to others health and medical bloggers to take a few minutes out of your busy schedule to add to the survey data. Deadline to take the survey is October 15.

Also check out Fard's interesting post from today covering the relaunch of Organized Wisdom at Healthcare Vox.

Medicare Physician Data: Transparency vs. Privacy

iHealthBeat provides commentary and an update on the outcome of the Consumers' Checkbook v. HHS matter involving whether or not Medicare physicians claims data should be made publicly available.

The United States District Court for the District of Columbia ruled in favor of Consumers' Checkbook on August 22 requiring that HHS release the physician data requested under FOIA to Consumers' Checkbook. So far HHS has not appealed the decision and the data is required to by produced by September 21.

It will be interesting to see if HHS appeals the decision. Classic example of transparency vs. privacy. Brian Kleppner has more over at that The Health Care Blog.

UPDATE (10/22/07): The WSJ Health Blog reports that HHS has decided to appeal the decision requiring that HHS release data under FOIA to Consumers' Checkbook. The decision initially required production of the data by September 21 which was then extended until October 22.

Joint Commission Launches WikiHealthCare

iHealthBeat reports about the Joint Commission's new pilot wiki, WikiHealthCare. The pilot project is an effort by the Joint Commission to create a collaborative space for open exchange of information among health care professionals.

According to the article, the site now only has 1,500 registered users and only about 10 actively posting to the wiki. What's a wiki?

Modern Healthcare has more.

CMS Stark III Regulations Now Available

Today CMS released the final Stark III physician self-referral rule available on the Physician Self Referral section of the CMS website and will be published in the September 5 Federal Register. 516 pages of light health care regulatory reading for the Labor Day Holiday.

The Phase III Stark Final Rule (CMS-1810-F) is officially titled, "Medicare Program; Physicians' Referrals to Health Care Entities With Which They Have Financial Relationships (Phase III)". The regulations will be effective 90 days after the publication date which is expected to be September 5, 2007. Read the CMS press release.

UPDATE: CMS has also provided an unofficial redline version of the Stark regulations showing the existing regulations and incorporating in the new Stark III changes.

UPDATE (7/5/07): The official version was published in the Federal Register on September 5, 2007. A complete copy of the regulations can be found here. The effective date of Phase III Final Rule is December 4, 2007.

UPDATE (11/11/07): David Harlow reports that certain provisions of Stark III will be delayed for up to a year (December 4, 2008).

Below is a copy of the rule summary and the table of contents directly from the final rule:

Summary: This final rule is the third phase (Phase III) of a final rulemaking amending our regulations regarding the physician self-referral prohibition in section 1877 of the Social Security Act (the Act). Specifically, this rule finalizes, and responds to public comments regarding, the Phase II interim final rule with comment period published on March 26, 2004, which set forth the self-referral prohibition and applicable definitions, interpreted various statutory exceptions to the prohibition, and created additional regulatory exceptions for arrangements that do not pose a risk of program or patient abuse (69 FR 16054).

In general, in response to public comments, in this Phase III final rule, we have reduced the regulatory burden on the health care industry through the interpretation of statutory exceptions and modification of the exceptions that were created using the Secretary’s discretionary authority under section 1877(b)(4) of the Act to promulgate exceptions for financial relationships that pose no risk of program or patient abuse.

I. Background
II. General Comments
A. General
B. Compliance with the Anti-kickback Statute
III. Definitions--§411.351
A. Employee
B. Entity
C. Fair Market Value
D. “Incident to” Services
E. Physician in the Group Practice
F. Radiology and Certain Other Imaging Services and Radiation Therapy
G. Referral
H. Rural Area
IV. Group Practice--§411.352
V. Prohibition on Certain Referrals by Physicians and Limitations on Billing--§411.353
VI. Financial Relationship, Compensation, and Ownership or
Investment Interest--§411.354
A. Ownership
B. Compensation
C. Special Rules on Compensation
VII. General Exceptions to the Referral Prohibition Related
to Both Ownership/Investment and Compensation--
§411.355
A. Physician Services
B. In-office Ancillary Services
C. Services Furnished by an Organization (or Its Contractors or Subcontractors) to Enrollees
D. Reserved
E. Academic Medical Centers
F. Implants Furnished by an Ambulatory Surgical Center
G. EPO and Other Dialysis-related Drugs Furnished in or by an End-Stage Renal Dialysis Facility
H. Preventive Screening Tests, Immunizations, and Vaccines
I. Eyeglasses and Contact Lenses Following Cataract Surgery
J. Intra-family Rural Referrals
VIII. Exceptions to the Referral Prohibition Related to
Ownership or Investment Interests--§411.356
A. Publicly-traded Securities and Mutual Funds
B. Hospitals Located in Puerto Rico
C. Rural Providers
D. Ownership Interest in a Whole Hospital
IX. Exceptions to the Referral Prohibition Related to
Compensation Arrangements--§411.357
A. Rental of Office Space
B. Rental of Equipment
C. Bona Fide Employment Relationships
D. Personal Service Arrangements
E. Physician Recruitment
F. Isolated Transactions
G. Remuneration Unrelated to Designated Health Services
H. Group Practice Arrangements with a Hospital
I. Payments by a Physician
J. Charitable Donations by a Physician
K. Nonmonetary Compensation
L. Fair Market Value Compensation
M. Medical Staff Incidental Benefits
N. Risk-sharing Arrangements
O. Compliance Training
P. Indirect Compensation Arrangements
Q. Referral Services
R. Obstetrical Malpractice Insurance Subsidies
S. Professional Courtesy
T. Retention Payments in Underserved Areas
U. Community-wide Health Information Systems
X. Reporting Requirements--§411.361
XI. Miscellaneous (Other)
XII. Provisions of the Final Rule
XIII. Technical Corrections
XIV. Collection of Information Requirements
XV. Regulatory Impact Analysis
A. Overall Impact
B. Anticipated Effects
C. Alternatives Considered

Comments on the new regulations:

• Brian Peterson at his West Virginia Legal Weblog provides insight into the new regulations clarification of physician recruitment agreements and restrictive covenants in physician employment agreements.
  

Thanks to the AHLA Stark Law listserve for the tip on the final rule.

Why We Need A Health Care Revolution

Dr. Val Jones' road to revolution provides her personal perspective on the current state of our health care system and why we all need to work for change.

Don't miss the rest of this week's Grand Rounds hosted at Med Journal Watch.